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r. <br /> Slau Or Caiikrnia-Environ ri n of Prow' Agenc� <br /> Porn.Yepr04ed OMB.No.2050-JOJ4 Espirne. -7P 41'IL_ , SEB Instructions OFI bC<IC O�e 6. <br /> Plea k,3nnwor type. Por.designed hit we an. 'ib I A2-pitch) ritrc- Deoortmi or Tozic$uos>� - <br /> v S.CI.Thi ro.Caine- <br /> UNIFORM HAZARD US I' G°"°•erorI US A 10 No. ,Manifur Daeumanr No. ?. )age I i 'intimation In me shaped os <br /> WASTE MANIFEST I �, I I not reo.ired by Eedeol is <br /> 1 3. :'3enerame5Nameand Mailin9 Address _ <br /> ShmM1ftln F>«wwsi.Wl <br /> WARE SIMRA ?A?E3 CCV. Y a ' r , <br /> 4i °Cci W. --incl ST2 S' Cu :K, C.i 95.Cr? s Sw.�p..o ttl cep TM — <br /> \ <br /> ry Coercion, <br /> N <br /> n 0. US ZPA;0 .moa G.Shod tr awporew-iT m4 <br /> r ,Y• •*^•i <br /> p <br /> Ot am •SlTT3(,Mue..,rL uPFane <br /> - N 3 US A 16 'M;Shb wT' !paned lfF 5 r <br /> <I I I I j I I �-c�maspaaets.Pflavec.� �s�e�� a — <br /> 9. 0.,Tgnarea x N Name ana Site Address <br /> .� ! 0. US..AID Numoer _ — <br /> 1/ I I i M L, 210. <br /> C 5C Imo!-:a[ ti <br /> ir <br /> 1737 itaT +T VI, WILL"i:NGTON, CA 90744ve <br /> Faar� a aaaR: s <br /> -Cli I. 7- <br /> 1 l. US DOT Disc conn linciuding P-aoer Shilling Nome,Ha oro Cass.and D N.maeri ^ra^en orm i4 Unit I x <br /> ^zi 'tea `NI/Vol ;'f„WosrmNnre@". <br /> -ik- SM <br /> T_ VCN-,RrA :A.ZARr;)US SiASTE- SCLC <br /> E Zing <br /> N ! It. NON—RC2A HAZ1RLnT 'E iS LiAS S"L <br /> 71 s .� t <br /> �i�I T VON-?C'{A :?AZARDCUS tj.A Z Set k, <br /> O vim} <br /> VA:—j' 96=_71 EPA(O n w <br /> �f f r . T I � /�I,�Ie/I j '.I � I +s•1�/�a�e'-nr - — <br /> J I I I I I I r <br /> '1 IY-.pdo7r 4Elescrnzf; Malen ti["imrFAFc•--w7, ':1 {''.., � ,.s"`,{• ,.� k^uFfurdMngCaaesraeWwias.Fnre ;6 .� v-r4 <br /> — <br /> I "� "el�>r''rt iSv,.�,Ky. }r � ��.7�•°,�"'�t`.'P���e�s.'.x�"��e`€�Y'�'�t�" -nom.",yF',,.,'w_K�rae•�'x'T- _ _ <br /> - <br /> � � _. Special 4onal'ng nsroc ens and Aaainana"nmrmar an - <br /> Ji I EMUGDCT (7`NTlCf (glA) 471-5747 <br /> Q <br /> 16. GENERATOR'S C 11TIFICATION hereby dell., rnar the camenn or th s ca 'Innen,are Fully nc accurmsiy a cri bed ab - Oa r vhipp'n,nom.ana are cl.nziied,pocket <br /> s <br /> ,J marked, no aoeied.ano are nail resp.cn.roper ondrt On Tor vanspo r by highway acc ,ding ro opp.cvole in,ernorional ono notional g.y.mmnn TepI.fi.h, <br /> J' If I am a large ltni, ry general.,.I terrify Thar 1 have o pro lace ro reduce the volume and roxicily or y.osre generated ro the degree 1 have determined:o be aconon. <br /> pocficabla and that nma selected The praaimhla melnod program <br /> storage.x disposal cvrrenrly available to me which minimizes The orasen,and htl.re threat to human-a <br /> m and the environment;OR,ii am a small gvandry general.,, have made a good iairh effort to minimize my+osre generation and wiecr the lues,waste management memo, - <br /> i7 available ro me and rnar I can oWord. <br /> >- Pjov:d/Typed Name - <br /> signs -� / Month Day <br /> -71 <br /> -' 1 17, Tronsoormr I Acknowled amen,of Rm,nd,of Mdh,,.dls <br /> u A Printed/Typed/Namy/'� Signature Month <br /> LI P Jy`�' (-„ - 1'.� �""�G 1.I .`IT-r• it /• �i f _. <br /> Q0 18. irvnsoartar 2 Acknawieo amen,ar Recamr of,`earer,tik - = <br /> ', Prinrad/Typed Name <br /> w $ignawe <br /> Q .Month Oay <br /> n A. <br /> U 19. Discr.panry Indicarian Space -- <br /> Z F <br /> - . A <br /> c <br /> I <br /> L <br /> I 20. Facililr Owner a Ooerol.r Carnhmtion ar reasior of hazardow materials layered b this maniiesr..,.of os pored in item Month Day <br /> v. <br /> T Printed/Typed �ef $ighwavie ' <br /> Y / ( r a <br /> -- <br /> �' DO NOT WRITE BELOW THISLI%E. <br /> DTSC 8022A (x/97) <br /> EPA 8700--22 - Green: TRANSPORTER Q`_ <br />