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Form Ap"_vad Oxi(B No.2050039 FE�'�nr9�p:y9} s , r �. Jee IRSTCLCTIOR5-Vtr t)acic,or pogo o �,w, ,:e1. torrsoxrcJuwtorlcee Lonrrvr <br /> ~ 9 P prldrj lypewrr ''�'wr a.r v► •;.'° <br /> P1ea�e gilntl or type.- form des' reed Parini ar�lr1e f 2 rer _"> __ :4-.�� Ear �. r -�• ,- <br /> F --- --- 6 -]. GeneroWs US EPA ID No -�f x. �3r Ma<uissT Doarirsenf No 's',: t •;?ago' , IrrEwn tliSr%!ds�Yb°der arcs' `ti C rr, <br /> 1�NIFORM HAZARDOUS � • •_• �;`� Ti. r a na rsr�ererJr6rradeiaTlaw <br /> WASTE MANIFEST C 'D 9I 8 :3 NO Q 0 .5 _ �A WAR <br /> 3. et�nerator's Name and Mailing Address}}•� yyyy 7 q�► Y,.��, <br /> ReS.R sJiaR .0 tG�T�.42s• hire LTH Pf.!!.6,-. Im. ki- <br /> - <br /> r7'�"73 7�a*at. �� r*'tr 'aCrak'f-OSt, 4� x'!10 a ., •-- i�l. -`' <br /> 4. Generator's Phone (209�1476-2.00 0 <br /> CV 5 Transporter 1 Company Name & US EPA ID Number <br /> m YV:�y�,r � c:at�:,n dpi al:s <br /> �S1i7sPer12L-sl1relE'+rrual s) {} 3 ° T`a"sp°r'«s PI'°n° i 3"rS26 ' r <br /> aJ 7. Transporter 2 Company Name• ,8. US EPA ID Number E. Slate Trvnsporioes ID Reserved I <br /> A� - <br /> I'_ Tronspoilw',Pham .. , <br /> i 9. Designated Facility Name and Site Address 10, US EPA ID NumL er G .Slate Facility's ID <br /> a Y3 SEF. ( C{ b t? 9 <br /> ac ?4 �tECQIt� :7G)t 4`2L <br /> H Facility's Phone- <br /> t <br /> CA a4^1 �' A �T+ ? 3 E• tr n cx <br /> 510-559— ` rt` <br /> 12. Containers 13. Total IA. Unit '-e <br /> J lJ I I. US DOT Description(including Proper Shipping Name,Hazard Gass,and ID Number) No Type Quantity WI/Val F 1Wade Number <br /> ya�.KK <br /> Z Sriatr <br /> a. <br /> = IQ, 'cuazLr�aows 9Ptitstt , Liquid, X.0. �. <br /> T17 � <br /> , (Silver) EPA/ol '_ <br /> E s,.�.. <br /> co E AlCnFtiir _ :'r <br /> v R <br /> A <br /> co O <br /> fY' �1a16'�l .[zl1��v" tir LY <br /> LU <br /> LU <br /> V) J. Additional Dowripfiom For Malriah Listed Above t v K Handling fades Sof Wasteilsshd Abwd <br /> %wet IL=. VWLr4.4L� .- 1 sr A V� r'Y 5 _uri 2FE �S1 1 <br /> A <br /> -� '�' ' -�-��••� R`'4r i <br /> _ �7�ir 'S^""r �►er' k r t .`r�z s ' ?>` a x u. a Asx. °-C`e° -- t- <br /> Q - - =1.-� .,L .._..tom ,..,,c_:- ..xisc... 7va.. .. .i^ r5 <br /> Z1 S. Specks!Horsdi^y hestrsrrsiorss and Additional Information w~ LAIW <br /> .r J C5.1 # J t i . <br /> P.- I�►'ear prntecttve egs2 .(Gio'lef.&goodies.) poevi ed cbrwitsrerrt:DOI If.aj <br /> Z GOT � f 1171 <br /> Tre to E� 1 Grob: Nomwoste7twer Trea�mcnt Stmdvd:Z2CCP 66268.40 <br /> LU ER-ftry}e"oar *C(: 800-424- 3kJO SAvwGorrterrt: E54G- 3i DPIS <br /> 18. GENERATOtrS COM1CAT*N: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and aro classified,packed, <br /> Q mar}ed,osd labelyd,and we in all respects in proper condition far transport by highway according to applicable international and national qov mmant regulations. <br /> V <br /> If 1 are a urge qusfry yenrator,I certify that 1 have a pragraen in place to educe the volume and toxicity of,vesro generated to the degree t have determined b be ecasariiaa <br /> a pesser6le eed irl 110+edtled 11rpac mrt{sad a#tr>sahrswd,storage,or disposal currently available)o me wi,ich minimizes tf+a present and fsrtun threat to h+rnsort <br /> and by ee`irarserov;09,a I ow a trod apurs�hp,tese ohm,1 have mode a good Faith sigort so minimize my waste generatlion and select the best wusN nsanogwrAwd rnaAtod tllsat ie <br /> oc arnairdfie is er ansa the t tee afiard <br /> O IkirredRyytd H`e <br /> } <br /> Z f r L r" r <br /> C24 Lts <br /> 0 . 17. t ti l al d Moeeriafs r� <br /> Uj <br /> L 4 P + - <br /> W �i <br /> LL. ! 2 d d tMot.nele <br /> U 'T Pr,,,$WfTyped Mame Signature Month Day Year <br /> rami E <br /> Q I <br /> (� 19. Drscreporscy Ind-cation Space <br /> Z A / <br /> C <br /> E <br /> L <br /> I <br /> 20. 0r.rrr o. Ceetifsas000 d of fsazars7asrs oted in rn 3 9 <br /> materials ooveeed this months teat as n <br /> T A; /T t Signature Month Day Year <br /> Y d"I �s <br /> 'BOD NOT WRITE 8E OW THIS LINE. <br />