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<br /> 11 �7lJ ./L SaCmmm,a,California
<br /> _ �yNIFOR/Y� HA�R�US ^WM(4 US EPA ID No. Mani6ml Document Nasi 2. Page 1 bfermarian in the shaded arae,
<br /> WASTE MANIFEST Is 0 0.0 2 148' 4 a 7 6 5 9 9 a aft wr regaird by federal law.
<br /> 1 A, 51aN Manifasr Daaament Number
<br /> WUD AVE. 25133979
<br /> a56 90[rfH
<br /> $
<br /> - Wlil CA 95240? 6556490 E. Star,ten.amrr ID
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<br /> A. Gmyabr',Phan.l I uT �,
<br /> 5. Ymn-porW 1 Company No. 6. US EPA ID Number C. SsaW Tmreportef,ID t�,l
<br /> P; 21st CEMJ" Y FMI
<br /> oom CAR 0 0 0 1 6 4 6 1 2 D, r as pa«',Phase—(a77)748-3040
<br /> — 7. TwnW"r 2 Company Name B. U5 EPA ID Numbs, E. StarN,Transparle/s Ip
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<br /> Q Q C P. Traapart>'s Phone
<br /> rsPs�Qdlry 4' . .1SL
<br /> 77{ US EPA ID Number G. State Paaw,ID -
<br /> iz� 20245 77AVEME r Welts
<br /> ,70 KMT, (� 98032 H, Pec fV!Pham
<br /> NAD 9 9 1 2 3 1 7 6 1 (253) 872-8030
<br /> JU 11. US DOT Description fir'Judng Naps Shipping Nom.,H.,d Clase,and ID Number) 12. Conminyr 1 J. {Wal 7/. Unit
<br /> No, T Quami WtNel L Wats Number
<br /> RQa-IM AMM 3 M11" esti 0But seer IrI State
<br /> 212
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<br /> 0 15 tb 41 Insnualbns and AddfEawlnfor
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<br /> 16. 6FNEpATOR'S CEft11i9CATghk Iherb
<br /> marked,ad labdd,am are in ally yds<Iae Nmr dts conrmn aF Wa consiynmenl arefullyad aurumM.0bleibedabovebynd",shippin nameand are dassihd, ked,
<br /> V ypech in proper condition Far ken-PeM by highyy accordl„g b applieabk inmmWionol and narbiwl gorW nssml regubNms.
<br /> IF 1 am a large yuansity gmerabr,I terrify that 16 v,a pragram in place M reduce rhe volume and bxidty f waste,.ar w b dre degree I hove determined b be acanomicallr
<br /> y prad,cabb am that I hors elected the pmctimbl.m.lhed of heahn.nt,savage or disposal cenenHy ara7labb b me..hich minimlxa fhe
<br /> and th mviroynanl ON,If I am a smod ummiy generular,I have mad.a good faith affoA m mmimim Pryard and fuNre rhinal ro hunwn heof
<br /> O arailabk to me,and that I can offord, na'`-'oke gmerorion am-deer rAa best writs management matted rho,is
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<br /> ,teF ei o{Molerids T �, 0-16
<br /> w A Pri.NWTypd Nome Si
<br /> Month f Day Year[
<br /> O 1 Ig. Tran '2 AC ad ,of Reed of MmeKals I ` '� v
<br /> r Pri=4a ed Name
<br /> 0 A fed/'Y! / �Qjiil re Q */� Year
<br /> V P 19, Dls<,apoeay Imitation Spoce 7 -
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<br /> I 20. Facility Owns,ar stet Cerafi<oAen dr.<d dMxWdous maN.Ie6 crnWd b this manif.g t a noted in Item 19.
<br /> TPrin_roiled Name Signature
<br /> T l—.. Marlhh ` Day Year
<br /> DO NOT WRITE BELOW THIS LINE.
<br /> DTK 8022A Yellow; TSDF SEND5 THIS COPY TO GENERATOR WITHIN 30 DAYS. -
<br /> EPA $700-221,1 IGenerorors who submit haaordous wash for transport oW-of-zbte,
<br /> Produce Compleled COPY of Ihi,copy and ,end b DTSC within 30 days.)
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