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17✓22/2003 12:22 5306665705 NOR CAL CON PAGE 03 <br /> j"of C°lil°mlrEnvirmmseal PratecSm Agency <br /> fpm Approved OMB No.2050-00791Enpiro,9-70.99) Us,IflRI►YCIlDIIf M'rPC�E OF ,• Department of Toxic Svh+NnNt v°I <br /> Plpu prinl or type. form da9i9nad lar ase On lis.112-pifthl rypmmilar. 5aeromenm,Califmnlo <br /> CMwraei US EM 10 Na. M f aj DuenMal NO' <br /> '1 .2, papa, Mlommion in the shaded arms <br /> UNIFORM HAZARDOUS Q isnot aq..red by federal law. <br /> 1. <br /> WASTE MANIFEST Of <br /> 3 r.°It�nPrNama°rid(�Pilinp Addnu .."'111Fw'. Discontent Nunh.r2113959 : <br /> � eN('� <br /> sY'ra• 1 +M <br /> rdlm+vlD' <br /> n <br /> A Cnmrabr's Ihana I ZCIP L `"T 4 + L•..7?y <br /> ria 5, Transports 1 Ca spary,Name d. US CIA ID Nmebev C% gpry'trygep}rfe/s ID s r�.1 <br /> e 21 <br /> m 7. Transporter 2 Company Name E. US ERA b Nu er d W '1 <br /> tGmAferlu"e a <br /> 1U 9la gG�t 10, US EPA ID Numberma old. <br /> -a <br /> ILL.v 12. Consul.... 17. Tocol id. Unit <br /> �s 11. MDW 0.scvipllon(includiap proper Shipping Name,Ibwd Ctese,and IDN—her) No. 11 T Ovanti WI/Vol <br /> I. Wa+N NumMr <br /> 5NN / <br /> i <br /> E <br /> Is. <br /> SNN, <br /> c N <br /> m E EPA7 <br /> R <br /> v A e swo _ <br /> {� T <br /> m O EPA/Orbdi <br /> R <br /> oc awro <br /> F d. <br /> I EPA/Oder <br /> U <br /> Z <br /> 6i r <br /> IM , <br /> Q h <br /> '� r n f✓Js ; 1ci r � <br /> �] P�y ii� q y K.IiEAA�Y lL Vr 4,L'- KA 11S J".1, <br /> QO 15 Spec alm roiling Ip ria rrd Addigonol Ink��mm°don, <br /> � ;�p f/y y J+( �. ' r /y jtM"� I'✓ r i' [ r'% v/ <br /> F f •f<':t r �.1 � r -'r T J+�r, /1:Y' ,✓ I .L!' '�/�,�r- y A! <br /> < �V•r,y 1. ''..rv'yT 1."}'./v'"a df �V ' Gc•4'(, L C."T/ <br /> G <br /> 14. GEN ed,and l CTed,and <br /> i I heroby d,r In pr� f lM canbnls low <br /> it po rignmenha a,y and aceur!"lp cribed above by proper ship al'94 roma and am classified,peeked, <br /> marked,and labeled,and are in all mspeNs in p.oper condaim(m transportby highway oacordirq m applLeobte im.rnnti°nal and nali°na pwammanf rapvbliom. <br /> 111 am o largo gmrdigmNraror, csmily dIW I hws o proprqm in place to rdun die vdvgn and m.iciryry f.roma penereted b she dprse 1 hew demrmined b be enonamia <br /> Qa, Pmmimble and dear IT...selected the rocticab6 method nF awinsomr,alwope a dfpwal awromly crailable to me which minimizes the prnent and fuwro throat m human has <br /> s'llO and rho enrlmnm,,;m.if I am a rm.if gaonfily gworwar,I have mate°good 6i1h eRam moria my warm penerndon and sated the baa wrote manapanem medmd dm <br /> aw11ab6 te nm and Ihm I can af6rd. <br /> I's /Ty [ . ' Sipnalvr A Month Day <br /> Z <br /> W T 17. Trasuportis, <br /> l IyAckno emsdd R..i t of/Materriialls <br /> nyAYT /}' v� <br /> Ir j}IN+ L V N{,� P� + 1 sip r_ �y 4 Mach Day rm <br /> j I8. Ti/co"n r 2 A<kn mem of <br /> lis,of Materials l/L <br /> O T Pr6mdrfyped Name Signowre Month Day <br /> N <br /> A <br /> u 19. Discrepancy krdication Stmce <br /> Z F <br /> A <br /> C <br /> 1 20. Fail' d oor or mm < flnadan of recsa a <br /> of m° rials cawmJJJd monilml.c fes rated m Imm l9. <br /> T prinmd/TypNome Sig u Mamh Day <br /> DO NOT WRITE BELOW THIS LINE. <br /> DISC 8022A I1/99; Green: TRAN5FORTER RETAI <br /> EPA 67D6-22 <br />