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Shrb of:alifom.-Emuct mMal Prosection Agency <br /> Form Appro ad OMB No.205G-=t(E inrx 93096) Sem Instructions on I3acI(eage 6. Department of Toxic Submnces Comro: <br /> Please ptm or type. ram den"d A./v.on eJif*(1lpirdl rypewriler. Saramenro,Califem a <br /> I. Genamor't US,.EPk ICTNo. Manders Daeunimm No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS j not repaired by Federal law. <br /> I WASTE MANIFEST — <br /> i <br /> 3. Getrrmor't Nome and Mailing Addams <br /> ri 4E;,A--- SIEPA PAPER 3C9 -^ -C'TAYT <br /> h {. Ge:rraror's Phar 1 P) •G Q= IS` -e t i <br /> C? <br /> O 7. iransponer I Company Name 6. US EPA ID Numoer <br /> ml <br /> �I o •... -.�-r�n.•+.-....,,- �.T-..mac h l-. I., I, <br /> Q 7. Trbnspo&er T Compdny Name - - 3. OS EPAID NumaerMal <br /> U a - <br /> a j I I I I <br /> 9. Oepgoan d Fadlity Name and Site Add.. 10.I US EPA 0 Number <br /> �o� i7'7 1A Si 2EMI„ IMt�•..''INCTI:'N, Cl 4Giii <br /> - <br /> 11. US DOT Description(indbding Proper Shipping Name, Hazard Class.and ID Number 12. Containers 13. "oral I1. Unrt <br /> Z 1 No. i pe Quantity l `Mt/Vol It <br /> a <br /> r E (3::R.S—= 5918; 71do N <br /> / ,cytiA.'s x <br /> r ..- r 1 <br /> •v i E <br /> "Tp a ! <br /> 0 I z <br /> Z <br /> ,, yY <br /> - <br /> C1 x Mme . <br /> - <br /> Q. <br /> L <br /> Q 15. Special Handling nmvcnona un/�a Additional Iniomation ' <br /> `j 1 ..a <br /> iamu .. 3(} ,:VvR ..'.5ljJl/stl:'..l <br /> JI �'Y Ct�7LaC:: f91$ 371-57&7 <br /> 16. GENERATOR'S CIRTIFICATION: I hereby declare Mas the contemn of Tis coraignment are fully and accurarmy described above'cry proper sh,apmg name and are d.cufied, <br /> Q j packed,marked,and labeled,and are in all respects in proper condition for tanspa&by highway according to applicable mr matiooel and noriawl government regulations. <br /> v <br /> If I am a large quantity generaroc I certify that I have a program In place to reduce the +plume and toAicdy of waste generated to the degree I have demrmided ho be <br /> J economically practicable and that I have wintered-he practicable method of treatment, storage,or disposal currently available to me which minimizes the prcseM and futua <br /> Hthreat to human haabh and the environ:nem: OR, if I am a small quantity generaroq I have made a good faith offor,to minimize my waste generation and solo&the best <br /> warm mane .method that is evadable to me and that Icon afford. <br /> Printed/Typed Nome Signature .,y Month Day I Year <br /> Z i 17. Tranmomr 1 Ackmwied ement of Receiof of materials <br /> (� A Pnmed/Typed Near Signabre '---- - Month Y. <br /> Year <br /> w Q �73. Tromoo&ar 2 Aumwled anent of Receipt of Materials <br /> A Printed/Typed Name Signature Month Day Year <br /> O E, <br /> N19. Oncrepe icy!micatan Space <br /> F <br /> U A <br /> Z C <br /> - 1 <br /> L <br /> 1 20. Facility Ow:ser or C rater Cemficatian of rxeios.1.1,...rdau,,materials covered by this monifess aan f on mind in Item 19. <br /> T Pnnmd/Typed Name ,7 Signature % Month Day Year j <br /> Y / L <br /> DO NOT WRITE BELOW THIS/LINE. <br /> OTSC 8022A (1/95) Green: TRANSPORTER RETAINS <br /> EPA 3700-22 <br />