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hftchmAgency InsYuns n <br />of a b. <br />Na a)* "9 of T&komce,Com <br />br urn oR @Winn (D �p Aft Sacramento, Coffornia <br />w str� - ' <br />1. s US EPA ID No. No. 2. Pop 1 Info n as <br />dw shaded are <br />UNIFORMHAZAR S is rot required by Federal law. <br />WASTE MANIFEST r I AC ? of <br />&a* Manifoo Dacwnerd Number" <br />3. 's Name Address J1?rs a e6 <br />0-,X/ <br />r <br />-�cS a c-aew+lars Vf ' <br />h 4 's _ `qQ 1 ms- <br />5 TrarapoMr 1 me 6. US EPA 10 Number C.' State T.anspora�sil7 ' x ��� <br />! Q. Troirportar's Mo"P k ' <br />2 Company Name 8. US EPA ID Number E. State 2 ifD <br />U Trona Ws Pboee, <br />< q DesignatedFacfiAy Name Site Address 10. US EPA ID Number - <br />z( <br />_ 3;z� e G� sc�t�G•-a./�� , CAr 6117 <br />r"' V 12. Containers 13. Total 14. that <br />__ Z it. US DOT Description (including Proper Shipping Name, Hazard Cis, and ID 1%.ber) No. TouanftWt/Vol <br />a"1-{ tA41 `0p t k1 A'S (C S< <-t.D <br />Cn ) j <br />GI <br />t >✓- t•"15 L�, tivtir�c� �' w�YG, �, / ,-t'csf' 1 <br />C4 E <br />Is. <br />er R A <br />T C. {� <br />tu <br />d. <br />w <br />e� <br />U <br />T A for fisted Abase b' y CodasAt <br />N -4- <br />CK <br />�t `(J �j <br />13. Special Handling Instructions and Addis oral I formatiorn <br />< - 71-0-1141, <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and aro classified, <br />,qt packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable federal, state and international laws. <br />V <br />r If I am a large quantity generator, 1 certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree 1 hove determined to be <br />"e economically practicable and that 1 have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future <br />Nthreat to human health and the environment; OR, if I am a small quantity generator, 1 have made a good faith effort to minimize my waste generation and select the best <br />waste management method that is available to me and that 1 can afford. 4t T/ <br />yE W. /•t Sngnoture 77 16 13 /Day Year <br />Printed/Typed pedNam <br />V <br />113 <br />Z T 17. Transporter 1 Acwiedgement of Receipt of materialsto / cur <br />0 A P� /Typed N /L ! n C � Day <br />P <br />Si o 18. Transporter 2 Acknowiedoement of Receipt of Materials <br />W a Year Printed <br />R <br />R <br />U.1 <br />19. Discrepancy Indication Space <br />VF <br />A <br />Z C <br />I <br />, t <br />I 20. fort" Ctwrwr or Certification of roc of hazwdous materials coveAd this except as kern 19. y <br />jped Month Day Yew <br />( DO NOT WRIT OW THIS UNE. <br />Whits: TsDF sms THIS copy To DTSC WITHIN 30 DAYS. <br />DISC 02A (12/91) To: P.O. Sox 300o, S=anwft. CA 95812 �\ <br />IPA 22 <br />