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Stolref ProfMfws.Apercy.. _ . —--— .--- —�—— <br /> FormApprowd.OMB No.2050-0039(Eq fres 9-30-94) _ti_S!!R instrvchons on back of p#6:- <br /> Departm.rp of To.K bobst Ca .l <br /> Meow print or typo. Form designed der use on etre(12pitc)fyr rot. <br /> "rotor's US EPA ID No ts`1-cG1r: -AWmfesf Doarment 2 Page 1 Informatim n Me shaded aroas <br /> UNIFORM HAZARDOUS s _v.,: .-�* z?s tea. ' = s y not requ rod b Fede al Ivw <br /> - r'`__WASTE:MANIFEST s '. 1j1!_' 4 ,Yafi mssbJ�: <br /> 3 Generator's Name and Mailing Address. <br /> M • Mt <br /> vi 7 A 5P <br /> �tOC.f��DfV `.71J sore ce, . s _ <br /> `1 - 4 Generatar's Phone.` -`ie '.--C.�••,_ In a, �T�.4"WiEAMC <br /> m <br /> p 3 Transporter 1-Company Nome - 6 .US EPA ID Number_ 7 <br /> Z o � •an." <br /> -� . Tromponer 2 Company Name 8.US EPA ID Number <br /> U <br /> Q 9. Designated Facility Name and Site Address .. 10. US EPA ID Number <br /> G t` oa741x$1D - <br /> o C}} r,iiGa`WA s7� rYlANA�5EM :NT z ^� <br /> OLD' Sk t:)n�g RD <br /> �< saS1 Y. 101 A D - <br /> _ 0 a <br /> U _-_ - 12_Coreoinen t-.13_ Total 14. Ung « <br /> .7Z 11. US DOT Description(including Proper/Shipprg1`N/o�me,Homrd.Chss land ID Number) No T peon' Wt/Vol 1 ,os{e„Nvmhar _ <br /> �3 G SI IQ$O <br /> r E °s <br /> m N b. - - Sloid - <br /> C9 E <br /> o T e. <br /> O <br /> W R - - _ MUMMA <br /> w <br /> U - 'j. -Ir <br /> -1.111 <br /> VI <br /> W <br /> Z T ^a <br /> Q 75. Special Handling Ins cfwrns and Additional Information <br /> - - <br /> zYO <br /> '1 <br /> t- - <br /> 16. GENERATOR'S CERTIFICATION: t hereby elect..that the coment4of the cotsigmwnt arc fully and accurately described above by proper shipping name and are classified, <br /> J packed,marked,and labeled,and are in all res in r condition far h highway accord' too applicable federal,stale and irft na is ml laws. <br /> Q P° PM+' PoW� °^W°rlM 9 "'% 'ng PP� <br /> U <br /> If�I am a large quantity generaror;1 «rtify that I have a program in place.o reduce the volume and toxicity,of waste generated to the degree I have determted to be <br /> E: "economically practicable and that I have selected the practicable method of storage,or 1 currently available to me which minimizes the present and future <br /> N environment;threat to human health and the environment; 9 1 am a small quantify ,m I have mo faith effort to minimize my waste generation and select the best <br /> waste mono at method that k avoilable to me and that I can afford. <br /> Q Pri /T Name: - - _ -.. Si re��� �Y <br /> nM ear <br /> 141 <br /> u z <br /> Z T 17. Trans .ter 1 Acknowled merit of ecei 1 <br /> • <br /> w Pri /Typed Name /1 _ - Sign is Day <br /> N (\✓ <br /> W e <br /> e <br /> o. 18. Tram er 2 Acknewled ment of Recd f of <br /> W Mweriok <br /> tl i Printed/Typed Name .. Sigmture Month Day Year. <br /> O <br /> W :+ 19. Discrepancy Indication Space <br /> N <br /> Q p <br /> V <br /> r 'r <br /> L - <br /> 1 20. Facility Owner or Chporonor Certification of ocrript of hazardous materials covered by this manifest...of as rated in It.. 19. - <br /> T Printed/Typed Name Sigrsature Month Day :.,Year. <br /> Y <br /> DO NOT WRITE BELOW THIS UNE. <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DA <br /> DISC 8022A (12/91) To: P.O. Boz 400, Soarom me, CA 95812-0400 <br /> E-A <br />