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Stale of Colifomie—FrAmmiumse Netection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-94) See Instructions on back of mage 6. Departri:Sa of ens sabsfornia control <br /> Please print o;type. Form designed for use an e0te(12pitch viroc Sacramento,the shaded dedlomia <br /> UNIFORM HAZARDOUS rotor's US EPA ID No. Mardfest Do ument w� 2. Pope 1Information in he laded a eas <br /> is rot required by Federal tow. <br /> WASTE MANIFEST A r) 9 -. F• I 9 9 1 of <br /> 3. Generator's Name and Mailmg Address A. State Mari Documen9 NumbgL ` M <br /> o F ON St it l AN [�]7 {N,I 9 <br /> r.0 , PDX 293, PIPOFI, CA '7536f, Ceneraar':ID f <br /> y�j 4. Generafor's Phone (1-19) c 76 7,N�1 I <br /> m 6. US EPA ID Number G Sfoie imnsparter's ID <br /> p 5. Transporter 1 Company Name <br /> pip D. Transpoder'%Phone <br /> 1`10rf til_ till 4 11 (-'09:l 667- 6691 <br /> 7. Transporter 2 Company Name <br /> 8. US EPA ID Number E, itaie imnspoder'S ip <br /> V T_Transpoder's Phone <br /> d <br /> Q 9. Desi paled Facili%Nome anSib Address t0. US EPA ID Number G State Fridiy's 10 <br /> � Z rrrl�,lrr- IE , ':FP . ICr <br /> o I ^.L Mor•'rFI FnT ptye Phon,, <br /> riJ r/ TT EPSON, F /� -F3 Rr l Y. <br /> 7 '1 <br /> a <br /> m U 12. Coneenen 13. Total 14. Unit <br /> Z <br /> 11. US DOT Description(Including Proper Shipping Noe,Hazard Clan,and ID Number) No. T Qsanl' WI/Vol I. Waste Nomber <br /> I.1nM Pr PA NA7 AF'DOUS III IST E' L I" 'IT) s Wyi3 <br /> 3 G st.10TFP t- 0J1 n nL T T G EVA/cher <br /> o <br /> E State <br /> r0- N b. <br /> ag E <br /> N R EPA/Ocher <br /> �y A Stare <br /> a T <br /> 00 O <br /> K <br /> IT EPA/Other <br /> Zd State -- <br /> W <br /> U EPA/Other <br /> W <br /> N <br /> Z J. Adddionvl Descriptions for Materials listed A <br /> O <br /> Q. <br /> TANK' BOTTOM WASTE, <br /> PINGATE <br /> 1. . <br /> 0 15 S,,1 H dl'.na Innro sons and Additional Information <br /> tr.- FP01.Et._-iTVL rLrl-rl-1T`II:; J•:.1" " J -i": : J011I.1Y J01:0$ I3Tt1'i SHOP <br /> Z "F liFr ' •.r 11'. t. CttJTArI : '<'t1�'-'Gf-.� f.r..a .•' 101 1r1 . C:iIARTEk '4 AY <br /> 'i1':!C1',TIJ1J, CA <br /> j 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> Q packed,marked,and labeled,and are in all mspech in proper condition for transport by highway according Its applicable federal,state and international laws. <br /> V <br /> If t am a large quantity generator, 1 certify that I haws a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and flsat I have selected the practicable method of treatment,storage,or disposal currently available to me,which minimizes the present and future <br /> Nthreat to human health and the environment;OR,if I am a small quantity generator, I hove made a good faith effort to minimizes my waste genera8on and select the best <br /> IY waste management method that is available to me and the I can afford. <br /> O Printed/Type o �' Signature Month Dal ear <br /> T 17. T,.O nowledemanl of Rec ' of Materials <br /> W Printed/Typed Name Sig re ,_,j' Month <br /> Day Year f <br /> s 114 <br /> o ID. T t o el R e{Mmbsieh <br /> W i Printed/Typed Name Signature Month Flay Year <br /> LL <br /> Q M 1 <br /> W 19. Discrepancy Indication Space <br /> N <br /> Q F <br /> V p <br /> Z C <br /> _ 1 <br /> k <br /> I 20. Facility Owner or Operator CertfOcathet of receipt of hazardous materials covered Mit manifest except as noted in Item 19. <br /> T printed/Typed Nome Sigrabre Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DISC 8022A (7/92) <br /> EPA 0700-22 <br /> I.—. _—_.____-.—..____--__—___ .—. .— _.__--__._ ---___—_.—.—_—_._— <br />