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FCPProwed�BNo.2050-0039(Expires 9-30A9I See Instructions on,back o e 6. <br /> P ease int or e. Form designed for use an elite(12-pilo britea 9 Department of Toxic Substances Control <br /> Sacramento,California <br /> UNIFORM HAZARDOUSS.0, rater's US EPA ID No. Manifest Document 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST <br /> �e�Y is not required 6y Federal law. <br /> ar <br /> 3. Generator's Name and Mailing Address Fest Docmnem N—n ber' <br /> t Fit <br /> Tezc�IseT Ccwsreucrtr„� <br /> O 163 ' - 6&rY E s B Stet f rafoi;ID - <br /> TOC,6TOAJ C/{ 9 S20S <br /> A. Generator's Phone I I <br /> rN 5. <br /> transporter <br /> p l��Company Name �q�1s,��p 6. US EPA ID Number C.State TconspoCer's iD <br /> kYERBREEN�N IIIA.SWIMS <br /> 0 orf p r Frone -- <br /> t r�^4 <br /> 7. Transports po <br /> 2 Comny Name B. US EPA ID Number Transporfar's ID .. <br /> U 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> r)i E�sVefp�R��G�sR,,,,E�eEE?l OIL,WC. <br /> ,l0 6 W Smith Ake IAM <br /> _LL14Mrk CA 94560 ICIAID191 41118 <br /> Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number 12. Containers 13. Total IA. Unit <br /> P f 9 Pe Pf"^9 I No. T Quantity Wt/Vol �mte Number ` <br /> Z a. <br /> t�,,OOs IL �iupryD� U <br /> O3 G NOVACRI,IV RM IY�:S r L EPA/Other <br /> T)r E 010112 ^a <br /> N b. Is t.. k.. <br /> m E <br /> N R EPA/Oche?:Y <br /> e A <br /> o T a- state <br /> W O <br /> R EPA/Other <br /> az LL <br /> F d. <br /> Z <br /> w P <br /> U EPA/Other <br /> w <br /> .. <br /> Z psies Listed Abo <br /> O o . b. <br /> uuss B <br /> w <br /> C C d <br /> 0 15. Special Handling Instructions and Additional Information <br /> Z• 24 Hoar Emergency Amoia Telephone No.:GHEMTREG 1.800-4248300 invoice t 7350 y O <br /> w DOT ERG III WEAR PROTECTIVE EQUIPMENT sales Qraer r 94P 377 3/3 <br /> Q16. GENERATOR'S CERTIFICATION:jheraby dedam diatthe contents of this consignment or.Fully and occurably desc ibed above by proper shipping......d are classified,packed, <br /> U marked,and labeled,and ore in8811 respects in proper condition for transport y highway according ho applicable%aternational and national government regulations. <br /> If I am a large quantity generator,I codify that I have a progrom in place to reduce the volume and tonicity of waste generated to the degree 1 have determined to 6e economically <br /> wpracticable and thatI have selected the practicable method of treatmenp storage,or disposal currently available te me which minimizes the present and futurnthreat to hamon health <br /> and the environment;OR,if 1 am a small quantity generator,I have made o good faith efadLi irsmize my waste generation and select the best waste management method that is <br /> ac <br /> ac .0.61.to me and that can afford. <br /> �. Prin yped Name Signature/ -�/ Month Day Year <br /> V 1 <br /> Z <br /> w T 1 rods der 1 ant 6f Receipt o a <br /> wL Printed/Typed Nome Signature <br /> E g^ month Day Year <br /> Us S <br /> P <br /> O <br /> E 18. Trans r2A kn ed emela <br /> nl ecei tot Maria 1. <br /> Us 'ER Printed/Typed <br /> Name Signature Month Day Year <br /> Q R <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> _ A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered hy this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Your <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(A/97) <br /> EPA 8700-22 <br /> Ye11—,. 1,FNIPATO R RFTAINS <br />