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Slate of California—Environmental Protection Agency tit . <br /> form Approved OMB No.2050-00391Expires 9.30-991 See Ins1ruC11ons as back OF Ilag6 b Department of Toxic Substances Control <br /> Plaose print or type. form designed for use on elite(12-pitch)typ c { Sacramento,California <br /> UNIFORM HAZARDOUS i' orator's US EPA ID No. Manifest Document No. 2. Page 1 Information in he shaded areas <br /> WASTE MANIFEST A f1 1 i s mol rpuiied by Federal law. <br /> 2 7 '6 11 :,,:o'1 <br /> 3. Generator's IN...and Mailing Address <br /> SAN TOMJ PARTMERS <br /> 0 <br /> 11291 N. ALF`f NE REt, 9TOC T'ORI., CA '-:05212 1 r <br /> urlJ. Generator's Phone r?f,1�J 1'jr}8—r) 'j'! <br /> N 5 Transporter I Company Nome m 6. US EPA ID Number $ s it'ID d7R CAI_ OTI._ C f3D 9 H 4 17 "t '35 <br /> 10 <br /> tv <br /> O� <br /> 7. Transporter 2 Company Name S. US EPA ID Number <br /> U 9 Desi sled Facet-TRarge nd Sill Address 10, US EPA ID Number <,bhj! +„q K r �b ;'rt"i <br /> Q I hlCilJ %F:1 'oF1: <br /> 'Z I�00 C Stl a'ST. a . v <br /> 10 _LTS ANDEL E5. CA. ''v+'rl-;_3 _ A � 9 •4 5? '•y p I >ay�*s g'i :i <br /> JUJ12. Containers 13. Total 14. Unit ! 'r ,1IyYdtr <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) d <br /> No. Type <br /> Quantity WI/VolXE _ r//mi4 ulnbm' ti •'!:. <br /> XZ I'l0Nb—PCRA HAZAPDOUS WASTE LIOUID <br /> ); G (WATER & SLLID3E) 0 01 T I 13 P,F <br /> � .. E <br /> oN b' - shh'• <br /> on, E :'° nv. <br /> v A ^` <br /> a T us <br /> ro O •A/ONief <br /> R 't C1 <br /> W d. �v'Slalev <br /> H <br /> U <br /> us <br /> �1ialsiMohiAddrtlonol Da crps ons fo <br /> . listed' <br /> 0 TANk �CICTO WA§TE'�. <br /> w RTNSATE <br /> of <br /> V ;: ark rt <br /> a� F <br /> O 15 Special Handling Instructions and Additional Information <br /> APPR0F'f;'[A FE F'F.'0TEt.T T':'E C1_01 H I i G <br /> z "EMEPC-ENFY CnNTF11'T! ' 2'09 )541 -9145" <br /> _ 'EE E. R, 6. t " 1 <br /> 16, GENERATORS CERTIFICATION: I hereby declare that the contents of thisconsignment are fully and accudde)y described above by proper shipring name and are classified,packed, <br /> ' <br /> Umarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and nalionaPgovernment regulations. <br /> J If 1 am a large quantify generator,I certify that 1 have o program in place to reduce the volume and toxicity of wash generated to the degree I have determined to be economically <br /> Npracticable and that I hove selected the practicable method of treatment,storage,or dispasol currently availoble to me which minimizes the present and future threat to human health <br /> and the environment;OR,if I am a small quantity generator,I have made o good loth effort to mi mice my.,to generation and select the best waste management method that is <br /> 0 <br /> available to me'and that I can afford. \! <br /> ). Printed/Type Nama // Si ahrs ' Month Do 3 r` <br /> /is\ r;,. 1./4 Pi G t /1. 7 d <br /> 5 T 17. Transporter IQc Acknowlad emenf of Recei 1 of Mahri s i <br /> l7 1 <br /> YPrinted/Typed No`me .i CJ SignaNre�r� / ! onDa� r-w <br /> P ky <br /> B 18. Transporter 2 Acknowladliament of Receipt of Materials <br /> O 'l <br /> � Printed/Typed Name Signature Month Day Year <br /> w E <br /> Q R <br /> U Indication 19. Discrepancy Space <br /> ZF - ___ - .-. ........ . <br /> A <br /> C <br /> 20. Facility Owner or rot i Certfic hon of ecei of hazardous materials covered b ihi an' exc 6s noted in ham 19. <br /> T Printed/Typed Name- �s ,ter Signature �' - f Year <br /> Y / �a <br /> DO NOT WRITE BELOW THIS LINE. «f <br /> JEP <br /> TSC8022A 0/971 <br /> A 8700-22 Green: TRANSPORTER RETAINS <br />