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3°11fes9"\ See Instructions on�ck of page 6. <br /> sigmd(or use on slit t-P7�1 typewriter. Dep rnerent of T..ic 3ubslam. <br /> Sacramenro,Califon <br /> M HAZARDOUS 1. Generators US EPA ID No. Manifnt Document No. 2. 1 <br /> Pogo Inorti1.the hadd arec <br /> TE MANIFEST -�. , F 1 s otr_gv_i�byfederal6w. <br /> ,raror's Ndme and Mailing Add A. Stow Ma - tt��� <br /> ll sv"'�<Y.` ..J✓ '. N bei 111 <br /> ri r �f,-G'{. r r B Slmc G .tors ID <br /> Generotors Phone 0091`0 �y ( aA�7 �� -c^s ^ Ve-1 1 <br /> 3.ETsr�ansporter 1 ryCo�m��pany Namr�ee� ��dEdpP 6. USS EPA ID Num6er C. mk;Tr portv�1�J- -� <br /> Lec+tt{f9fdE DRiadVrel�z+zlllL etzeeessuT.�/ <br /> ID <br /> u 0 $ ? 1 3 2 ! 2 D. iransportcr'z Phonc —/p—ta_�(p 2 c72—.xr, — <br /> 7. Transporter 2 Company Name 8. US EPA 10 Number ---- — --- <br /> E brae 4.nspoAer's 1D Re3erved.] <br /> F T pen Phoe _--- _ - <br /> 9 n <br /> . Designated Facility Name and Site Address 10. US EPA ID NumberS t Fa-- <br /> G I ID <br /> Z d"Io-n44(aA' tSSA+{j'r2StrL"<:G S A�'D u 5 9 k 9 4 <br /> JIM 1021 Beryesa f6aaA J _�1_1 1_ L 1 <br /> H. Fecduy'z Phone <br /> LL $Ref9195133 A D 0 5 9 4 9 4 9 1 O 144& 451-5f <br /> V11. US DOT Descdplion(including Proper Shipping Name,Hazard doss,and ID No r) 12. Containers 13 Total 14 Unit - <br /> Z a. ppy�, Ne- T WIN., is W t Nomher <br /> I f 7"r' Stare���r <br /> 3 c <br /> E �" �0 F` <br /> o N =t�rTT$ <br /> w E 'R <br /> O S.ir <br /> W R <br /> d. <br /> Z <br /> v <br /> Z ✓1da Tonal Deacrip' <br /> ME <br /> A , <br /> 75. Spec al Handl'ng Inso-vct'.n1 and Adde.noI Ivordaaton err➢ „ f av .: * z ; ,'?* <br /> O , <br /> a 24 Hour Emergency Response Tel.No,CH TREC 1-90t1-d24"9300 <br /> _ DOTERG47+t$ wear prota wcming ng <br /> BIB of Lad( # <br /> Sales Order# } <br /> Q '16. GENERATOR'S CERTIFICATION: I hereby declare that Rro contenh of this<ons;gnment are fully and amm�e�.described above b <br /> V marked,and labeled,and ore ie dl respects in proper condition for transport by highway ac<ord;n b a I Y Proper s6ippng ulama and an daaai8ed,pocked, <br /> 8 PP ioable interna8onol and naKonal government regulaRons. <br /> J <br /> a <br /> '"o'" <br /> 1am a large quan%generator,1 certify that I have a pro <br /> pgmm in place ro reduce the roleme and roaici of wade <br /> yy practi<aWe and that I Ewe selected the practicable mellwd of treatment,Stora tY generated ro the degree I hove doern,hmd to 6e ecorwmicdly <br /> and Rsa environment;OR,;f I am a small eon' gAa,m dispose(currently w.iob6 ta me which minimizes dmp resent and future threat to human Isea <br /> O q 14Y generator,1 Iwve ma e a of 1,snort ro minimize my waste generation and select the best wash management m lhod that is <br /> available ro me and that I can afford. ,, <br /> U <br /> PrialafyPOd Nome ig We <br /> Z . l Mandl, Day Ya <br /> T -- f7 ca <br /> R 17. rons r 1 Ackrwwlod emenl of Recei of Materials <br /> YA Printed Name <br /> u R i alure / <br /> u P MT,-,,,- <br /> !, « <br /> � ; 1 re Ackrrowl amenf of Racsi t of Materials V <br /> uT nted/Typed Name Signature <br /> _ R' Month. Day Yea <br /> P 19. Discrepancy Indication Space <br /> A <br /> C <br /> 1 <br /> L <br /> 1 l20. FadO Owner or rotor CediFic-fi-of receiptof hazardous materials covered 6y this manifest except as noted In Item 19. <br /> T I Mehra,lyped Name <br /> Y SigrmNre Moi lls <br /> Ysm <br /> DO NOT WRITE BELOW THIS LINE. <br /> TSC 8022A(1/99) - Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> A 8700-22 To: P.O. go. 400, Sacramento, CA 95812-0400 <br />