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Slate of Colifornic—Environmental Projection Agency _- -- - - <br /> Form Approved OMB No.2050-0039(Expires 9-30-991 <br /> Please print ar type. Form designed for use on eGle fl2-piWl)lypewrifar. See Instructions on back OFe 9 o 6. - <br /> P Department of Toxic Substances Corthr <br /> Socramenla,California <br /> F2095Newlarmis <br /> NIFORM HAZARDOUS Generato s US EPA ID No. Manifest Do ument No. 2. page I nformation fn the shaded areas <br /> WASTE MANIFEST CAD 918131613151 0 3 8 1 0 7 9 6 '5 of s not required by Federal law. <br /> nerator's Namo and MailngAddressDIC <br /> 055 INDUSIiLTAL PARK AVEN[lE � 3 r1yrn 5'erator's Phone NAN7� CA 95337 (530)886-0664s ter npony Nome 6. US EPAID Numbern.�``�Y?A_ksporter 2 Company Name 8. US EPA ID Numbergnated Fa<ilit Name ite Address 10. US EPA ID Number t 'Centuzy 37ff F- <br /> r0Newlands Dr. Fastley, NV 8.9 NVD980 3OT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Totals I A. Unit <br /> - No. T e - Ouanliy Wr/Vol La q;Ta m <br /> 1_ �-vllel l - <br /> 3 E U H I?�3,-B (2 4 C I ooh f2G 0128) giol � a <br /> m E b ° /—vi7L ���2 G lcc /1I S. afar <br /> A Ipdb Qn -if fps 0 <br /> t1�1 <br /> a Flo P <br /> R C ..✓LL _� V'-l� l lJr . F"Ll�vo(/ Z "EP O}fje• _ <br /> w <br /> d �/QGs t�MYJE�1��� oc-L�..Q�r Jf� (J •V e"C�rJ St to f�5., a�` "- <br /> V ALL-- <br /> O is �� .sndl„ggK:odes{” ,pSinl d.Ab <br /> w � a st�g'� '. y A �a Y� c�.. _n `s°` s• ib N.4^.1"4 '^+�`��'� - <br /> Q 15. Special Nordling Instructions and Additional Infonnolwn -- <br /> z KM PROPER PROTECTIPE CLOTHING. BNEEG&RCY RESPONSE PHONE (886) 648-9931 (1751 515 2777. <br /> W <br /> F <br /> Q16. GENERATOR'S CERTIFICATION: I hereby declare that the contents OF this co signmenrare fvllyandaccurawlr described above by proper ship ing name and are classified,packed, <br /> V marked,and labeled,and are in all respecfs in proper condition for transport by higkwoy according to app icoble international and nationargovernment regulations. <br /> -s If I am a larg gvantiy gena rotor,I certify that I have o pro gram in place to reduce the volume and taxiciy f wast.generated to the degree I have determined to be c II <br /> a' <br /> Prue" <br /> and <br /> that hwe selected the mdicable method ol treatment,stooge, y <br /> p or disposal currently available to me which minimize:the present and Future threat to human health <br /> 0 and the environment; at iF I am a mall quantiy generator, have made a goad faith effort Io minimize my waste generation and sated the best waste....gemenl method that is <br /> O wailabie so a and that I can afford. - <br /> YPrinted/Typed Name - SignaWr <br /> Z f((` �/ -- Month Day Year <br /> W a� 616 I t 1 9101 <br /> (� N U. Trans :ter 1 Acknowled amen!of Recei t of Materials / <br /> W MMonth <br /> Prfined/T Name Signaler - Year <br /> w Day <br /> P �rzvJ _ //� _ D �l / I �UIL <br /> I8. tans oder 2Acknowled .ment of Recei toF Materials <br /> EPrinted/Typed Name SignaNre ---- <br /> to - MonthDay Year <br /> g I I I I I I <br /> Q <br /> V F 19. Dis<rdpanq Indication Space - <br /> A <br /> C <br /> f <br /> E <br /> 1 20. FacFli Owner or O eroror C.rfi(ication of recei 1 of hazardous materials covered b this manifest excd t as now m Item 19. <br /> T -e,.d/Typed Nmae <br /> $ignatare Month Day Year <br /> 11 I 1 I � <br /> DO NOT WRITE BELOW THIS LINE. <br />