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State.&C.hfo'nia-Environmental Protection Agency <br /> Fern Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back o•ge 6. Department of Substances conn <br /> Please print or type. Form designed for use on elite(12-pitch rifer. Sacramento,California <br /> UNIFORM HAZARDOUS Generator's US EPA ID No. Manifest Document No. 2. Page 1 nformation in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST 6s , 3 6 7 of 1 <br /> Ge!ero,sI is Name and Mailing Address .,/ A S[oWhkonifest Document Number <br /> ,y.�Q B Stdt¢Ganerotor's ID <br /> : <br /> Generator'. Phone�6 ) 3 A C�se.s.. <br /> s 4 Transporter 1 Company Name 6. US EPA ID Number C State Transpoger's ID <br /> �VERGRER ENV NUMEWAL SERMB <br /> 0 CAD 9 8 2 4 i 3 2 6 2 D TYa porter's Phone <br /> 71 Transporter 2 Company Nome 8. US EPA ID Number E Stene Tronsporter's ID <br /> Transpatlec's Phone <br /> V 9. gpated Facility Name and Site Address 10. US EPA ID Number G. .ate faailsy's ID <br /> d 14�.y"wr ri'f flL.Eiv�{s5 u'V 103E)hoc. <br /> vZC Lsn)UZI lipsa f .'t"I H Pacil y s Are. <br /> Him 1C A 3 E1 5 S 4 9 4 3 i 0 1 1 <br /> J w <br /> Q 12. Containers 13. Total ld. Unit <br /> V �.-US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number( ,p. <br /> No. Type Quantity wf/val <br /> Z o. <br /> 2 Wzp <br /> 3 c Nan-RCRA Hazwd jus w ,Sold .0144/ T001510 <br /> 0 <br /> N b. <br /> E <br /> m <br /> 't A <br /> o T C. <br /> .! <br /> ro O <br /> � R a <br /> Z l� y <br /> Z . . <br /> W A <br /> Z 1 Additional Descriptions.ler Materials lasted As. - ,� i=s•'2 <br /> � i adt a <br /> a. .r• .sa>' a "r� s+ a tev+ rc'�r3 � +k' <br /> fir_..x sr r <br /> o. 6/1 .�v AAmqp yg' y .- t <br /> as: CtrT'RCRA Dieb ,Proth M ° _ it �'�-2 t'F <br /> Q C ,,_F""rrt,. .`."" ' ".�'.h.-.;*-,^ r_ b::vE z. a. t-t:' 'w ._� s:rt�x*'� ii h'xs,3•-,`a <br /> 0 15, Special Handling Instructions and Additional Information <br /> Q <br /> Z <br /> DOT ERGE9T��eaW Response Tei.No 510-79540 FSA M l asRng�t ng g/ 6 .f <br /> TXV- <br /> 16. GENERATOR'S CERTIFICATION: Ihereby delare that the contents of this consignmenfare Fully and occurobly described above by proper shippingnamTbdd ar cI s%R�l ed, <br /> Umarked,vad labeled,and are in all respects in proper condition for transport by highway according to applicable international and national governrper)f ragJhyrlotioJss.G�� <br /> If I am o Jorge quantity generator,I certify that have a pro gram in place to reduce the volume and toxicity of waste generated to the degree I,h`avgldb'tednisie'd to be«onomically <br /> d prodicable and that 1 have selected the mcticable mefhodol treatment,storage,or disposal currently available to me which minimizes the pat!phd fulu ee threat to human health <br /> N I <br /> and the environment OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the waste management method that is <br /> O mailable to me and that I con afford. <br /> Printed/Typed Name <br /> Signature Month Day Year <br /> Z E"P'rlf ST ��n�p5oall . mac_ a / o a <br /> W F17. Transporter I Acknowlodgement of Receipt of Materials <br /> W A Printed d Name Signa Month Day Year <br /> w C V .L�.7 o.✓ aG l� ♦ 9 cola <br /> F <br /> O1 18. Trans iter 2 Acknowledgement of Receipt of Materials <br /> TPrinted/Typed Name Si reMonth Day Year <br /> w E <br /> Q 1 <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered bythis manifest except as noted in Ilam 19. <br /> T Prinlid/Typed Name Signature Month Day Year <br /> r <br /> DO NOT WRITE BELOW THIS LINE. <br />