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State of California—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9-30-99) See Iodructlons on backge 6. <br />Please print or type. Form designed for use on elite (12-pitchlWiter. <br />UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. <br />WASTE MANIFEST t" a P R T d " f' 5 .moi q I -r <br />3. Generator's Name and Mailing Adr�dprg�eTTss 3 q r7 g ' ` 4 A: State Man <br />SF <br />o 40 E. CARMLGIfE' DRIVE, SA&", NA J�40, CA 92408s: store Gena <br />LO' <br />Ln A. Generator's Phone ( 909-;?{{vi'-3y3,�y'L <br />N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Tran: <br />LO <br />ao <br />E <br />N <br />b. <br />w <br />E <br />O <br />o <br />v <br />v <br />C>NSOL ii lA.!' ]) ASTL-, I ilii. IC 1A:U 19 18 1 g 16 14518 15 181 <br />®tet <br />w <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. <br />o <br />T <br />O <br />O0 <br />co <br />Printed/Typed Name <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />CROSBY 'AND <br />G. <br />R <br />V19. <br />� <br />LU <br />Discrepancy Indication Sp <br />0�,EBTUN <br />Z <br />-Z <br />1634A WES'f t 7Tl! 8 2ZE'; I <br />c1tL.C)NG <br />BEA04r C A 9081 a C A�� � g� 11 X 0 1 <br />o_ <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number <br />P f g P PP 9 ) <br />12. Contain <br />.� U <br />T <br />No. T <br />Z <br />T'o !�-ac:7_ <br />a. <br />Jiifmr 97, -AF.-I A4Q—Z.C4-'Z <br />Q <br />H <br />' <br />Z <br />3 <br />G <br />o <br />E <br />N <br />b. <br />w <br />E <br />Printed/Typed Name <br />v <br />v <br />R <br />A <br />q„ <br />w <br />P <br />C. <br />o <br />T <br />O <br />O0 <br />co <br />Printed/Typed Name <br />Lu <br />h <br />E <br />R <br />R <br />V19. <br />� <br />LU <br />Discrepancy Indication Sp <br />d. <br />Z <br />w <br />V <br />LU <br />V) <br />Z <br />J, Addrjconal Descrthans <br />o_ <br />1 <br />Printed/Typed Name <br />U., <br />T <br />Y <br />T'o !�-ac:7_ <br />Q <br />' <br />Z <br />I' REFER <br />DISPOSE CED 'WASTE W <br />u 1Ts G IjlfiNT oa o S 2Ec, <br />1077 <br />T'E RE �V � M Bft <br />PER -; <br />AND STATE �iVA77ONOAND <br />kc ottn_ ACigpr TREGUTATIna- <br />Department of Toxic Substances Control <br />Sacramento, California <br />a Information in the shaded areas <br />is not required by Federal law. <br />of x /%',%/-2,-a t -) n e i <br />13. Total 14. Unit <br />Quantity Wt/Vol <br />OV TON, O}� FOR <br />EY[ v OF TOXIC ,n�TES <br />ij <br />Q 15. Special Handling Instructions and Additional Information . " r <br />Zi EAR A:C'k'aiC)P TAS: SAP`L.T; <br />