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Slone at California—Era,.rmemol Protection Agexy <br /> Frr ,.Approved OMS No.2050-0039(Expires 9-J0 99) See Instructions on back ar n bC Deportment of Toxm Subs,.- <br /> Please print or type. form designed for use oa this,112 pitch, � >-.0 S� Sacramento.C.bfco- - <br /> UNIFORM HAZARDOUS Generator's US EPA ID No. Mandesn Dacument No, 2 Page I Information in the shaded <br /> , I Is notrequiredby Federol in. <br /> WASTE MANIFEST <br /> 1 toi ' ts � b 7zB7 1a , <br /> J.&mUorJ's N/ 2 DM ngv;Ld-dr{s 1�.pT7//TAII C <br /> � A Slate Manifest Document Nambe-r <br /> Cvm, 9.8027287 <br /> Q S. State GenerabrxlD6ak &Sp MoQ 4V <br /> - - - <br /> h d. Generator's Phone 1 Y2J ) Z G �,- �� / _ <br /> n <br /> N 5. Transporter 1 Company Name 6. US EPA ID Numbs, C'.�State TransporfefelPr,I'_ <br /> u1 <br /> C? ECOLOGY CONTROL INDUSTRIES F A 9 918, 21013,0 117 3 D,.Tionsporter,Is ae 510-235-1 355 <br /> 0 <br /> m <br /> "11m 8. US EPA ID Number E SlatT p rter'sE Trp sp hls Phone <br /> V me and Site Address 10. US EPA ID Number G-Sept Fac ys IP - - <br /> z 255 PARR BLVD <br /> C " Fa, Iy,DPhone 51 <br /> C <br /> ORICHMOND, CA :anot -25-1393 <br /> V Co 'tiey 17Total l Un 1Q 11. US DOT Description including Proper Shipping Name,Hazard Class.and ID Number Te ywlUtol Wasto <br /> �Nbmbci <br /> Z L 10 P . • S 1 RAG Ez 1 AN. . sane: -°51 <br /> 3 G Non-RCRA hazardous waste solido 0 / T .. 0 0 G EPA/lith NB <br /> NC <br /> o N b. Stat <br /> co E 'EPA%Other <br /> v R <br /> V A SI to <br /> 6 T <br /> co 0 EPA(OIhSr <br /> R <br /> m 5mta _ <br /> w d. <br /> Z EPA/Otho, -- <br /> V <br /> r�`pKo sjf�r'MglpncTleLQed A�ya'klt:: i' P _' `L ;w;1 mg.Ccdic'feY ti.sfe4sted Aho e _ <br /> Z z}r"wriP,T`f ST�5E3AGEr 5` �T14 <br /> +t_,r' .s.• b+:;> - <br /> Z n 4f• n'3 Tt.. /.fifir f Tis 1_ <br /> 24 Hour Emergency Telephone Number: q'2S 2 99•- jj�91 <br /> W 24 dour Emergency contact: PQ v <br /> ¢CA- <br /> 16. GENERATOR'S CERTIFICATION: Is...by declare that the contents of this consignment are fully and onwately described above by proper shipping name and are classified,p.Pic - <br /> Q marked,and l.bded,and are in all respect,in proper condition for transport by highway according to applicable international and national government regulations. <br /> V <br /> If I am a large ascrini generator,I certify thee I have a p, rcm in place to reduce the vol me and Iouuy f waste generated to the degree I have determined to be once --_ <br /> n. practicable and that have selected the practicable methodof treatment, storage, disposal currently available to me which minimizes the present and future threat sohumor <br /> .ad the environment;OR,If I on o .all gaantity generator,I have made a good faith effort to minimize my waste generation and select the best waste mon.gemem math., <br /> Pic ovadable to me and that I can afford. <br /> 0c <br /> Printed/Typed Name Signature Month Day <br /> U J7- <br /> w i 17. Trans rMr 1 a.cknowled ement of Recei t o Mated.l, <br /> P <br /> d' p rin omq Month Day = <br /> w d Nl � �- <br /> w S � f v'J r-'� / <br /> P <br /> O 8 8. Transporter 2 Acknowledgement of Receipt of Materials - <br /> R Month Dar <br /> Printed/Typed Name 5,naetur <br /> T <br /> w E . <br /> an p <br /> U19. Discrepancy lndic.fion Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Fade owner or O ernnor Carfihcotion of recta t of hazardous materials covered by this manifest e.ce i os noted in Item 19. <br /> T Printed/Typed Name Signamr Month Day -- <br /> DRvco �V" I b <br /> e'., <br /> �1LE-P- �=' DO NOT WRITE BELOW THIS LINE. <br /> 1 <br /> DTSC 8022A Id/971 as :000 <br /> EPA 8700-22 <br />