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$w*erf C4 Nornfa—Environmental Protection ney <br /> Form Approved OMt1.No,2050-0039(Expire+9.30.991 SSC If15tTWCF10T1b on back of page 6. Dapar+menl aF Taxlc S a(;6r ;a Centro) <br /> Please print or type. Form designed for use an etre(12. if irar, Sacramento,CCforna <br /> r�rotois VS EPA ID No. Me.!60 oecumenr^ 2. Page 1 Inferinefion in Hy skude+J ureas <br /> UNIFORM HAZARDOUSis net roquired by Edam)law. <br /> WASTE MANIFEST f• 0 q -I / 0 of <br /> 3. Gcncroror s Name and Molliog Address rs f <br /> A 5tata Main feel Docriment Number <br /> 4"9r �.. f�,�Ut� :i3 Sthte Generator's-ED <br /> 1, Generator's <br /> `C State Too ns ester's l& Rcscrvcd <br /> C•1 t5�-Trayns Transporter I Com on 'Name A jb. yU�S EPA 9D Number e ( P �---I <br /> . 3�1.T,iSt •�CS111!1S °�'81� 1; !1F A fs.. •1 Y =3 ,� nrran ipgrta(s P�,no1� - <br /> a � <br /> ao 7L ('IR q g. U5 EPA 10 Number 6 StafcTran porisr3ID(f ryt <br /> .., lLZ' 1 rAo.i�. Y iltx3.. C, I I1 f E2 a� ;F! ' r f �'j ' `F Transpo,"er P4anQ <br /> V 10. US EPA 10 Number G. $taro Foc;l+ry's[II <br /> 9. D.raiQnrarro�d��FaptirGyr�y7N�ama andj Sim Address <br /> Q w.�3rI3 tCYr6fnFr1A`[A.Pit��r 71sd'�. y;�� Y ':4 Fdcil' -- ♦ -- <br /> D1Z 2095 9RwL" ► All l Li}171. - . <br /> , rr0 <br /> V 12. Con%marc 13. lrorol le. Unit <br /> Vii. 115 DOT OpscripFon(including Proper Shipping Noma.Hazard lass,and IDN r) No. T e OuantiYy wt/Vol L,wai1e tVumber <br /> Sr. ! <br /> .S ',',A r � r✓- .s <br /> Dq <br /> E Stole <br /> w N <br /> a <br /> co E <br /> EPA/Otivvv <br /> ly! <br /> ^NsF A <br /> t, 5rara <br /> c+ T <br /> to <br /> to EPA/0+., <br /> R <br /> Of Slate. . <br /> d. <br /> H <br /> w EPAIOrhai'... <br /> V <br /> uv <br /> AdXI.�Handling Codes Tor Wacrai Lwad AJ?-4 <br /> C) c '�: ° b <br /> N 2 �'.r',, <br /> r <br /> LLj <br /> 41. <br /> fix <br /> z T5, Special Handling Inslructlons and Additionol^Informahan - - - <br /> (3 <br /> Ila. 111 <br /> Uj <br /> J.s 16. GENERATOR'S CIE <br /> RTIFICATION: I herady decdors that Iho contents of this cams; nment aro fully and accurate)y dascriberl obove by proper shipping name and arc r.Ia:siFiad,pacluld, <br /> 4 marked.and labeled,and highway according in all respach in proper condi6cin for transport by haccording to applicable inlernaCci and national governmen+regulations. <br /> V <br /> IFI am a large quant;y genarator, I aer0ly rhes 1 kava a program in place to reduce the volume and ro,riciy of waste generomd 10 the degree I have determined w be cconornxali <br /> cl provien6fs and that t hove selected the prccKaablr method pf rceartnsmr,srarage,or d'esposal wrrenlly ovailablc to ms which minimises rhe pre+enr and tutus ihrra4 to human kept h <br /> v' and rhe environment:OR,;f I am a small quanrity genoratw,I haus mode a good faitk eftert to minimi><c my wood Fonoronon and sleet tko best wo%N monogtri mc. +od thar is <br /> °C available re ms aid rear I car afford, _ <br /> I - .'•{ Month Day Year <br /> Primlo44105-9 Name( t S+gnarurs ) r s r` f r t r <br /> V #L.,� l.. r=."F 1 � ff�. "J 1`��;-�1n.:•�� 1 i3•trt/J,., s /' � �'�. C:l X°-C� i i � <br /> T 17. Trans r 1AG",w @der t of Aecei of Materials / —.._ .... - <br /> q r r f nrh y Y r� <br /> W Prinrad/ N f> $ipnatu � / •, <br /> W $ <br /> sL p 1 rano iter 2 Acknow7ednameni of Poiceicir OF Molerioic <br /> o T P Inted/Typsd Nams Signature <br /> Mantle Day Year <br /> w E <br /> to q - <br /> U 19. 04reponcy lndlcatson Space <br /> z F <br /> A <br /> C <br /> l <br /> I 20, Foci itry Owner or Q eroror Catificarion of receipt of hazardous magnets Oovared by this monif"s esc¢ r as noted to Item 19. <br /> T Printed/Typed Noms Signotwq Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> Blue: (+ENERATOR SENDS.Tst15 COPY TO DISC WITHIN 30 DAYS, <br /> DT5C 8022A (1/991 - To: P.O. gox 400, Sacramento. CA 95812.OAOO <br /> EPA 8700-22 <br />