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-3fate of California—Health and Welfare Agenc <br />De Ment of Health Services <br />EPA 3700-2/35) YELLOW: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS ENuP pCjVV SEav �G�J <br />1 <br />✓ Toxic Subelances Control Dlvlelor <br />Ai � li�l� fte a en err {! iATA tori ID No. — _ Man la• i• Paga 1 PIg��R 11 I�Sa7�j �{°�ng�Qyrd1� <br />Do/hl 1 `F•3t <br />Isw. <br />ASTE MANIFEST ' iitl� iQqul/i� 6y <br />!r+ cl <br />3. ton's N and Mdlirlp Address <br />—Rr/ t�Cej <br />�6401,C <br />s' <br />s. Generator's Phone ) S%ul _ + <br />5. ram porter 1 Company Name e. US EPA ID Number RM, rt <br />P <br />7. Tnnsportar 2 Company Nems S EPA ID Number <br />E., State Transporter's <br />B. signaled Facility Name and site Addroes 10. US EPA ID Number <br />F. Transporter's Phone <br />State Facility's ID <br />/ +t` X4 c k- e <br />_ <br />D1"qIl <br />H ac Illy' AQPP <br />X70 I(lif 11,143 <br />11. US DOT Description (Including Proper Snipping Name, Hazard Class, and ID Number) <br />12. Contains <br />Total <br />Unit I. <br />No. Type <br />Ouanllty <br />WVV Waste No. <br />T yr ' `d T ("� <br />AJ11,'7 <br />l <br />A b. <br />T <br />0 <br />A <br />C. <br />d. <br />J. Additional Descriptions for Materials Usteed� y� , <br />K Handling Codes for Wastes Usted Above <br />�Ij�� 8 ..}� i I�i • r � ITh^ <br />-/ <br />. <br />15. Special Handling Instructions and Additional Information <br />13. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by <br />proper shipping name and are classified, packed, marked, and labeled, and we In all respects In proper condition for transport by highway <br />according to applicable International and national government regulations. <br />Unless I am a small Quantity generator who has been exempted by statute or regulation from the duty to make a waste minimization certification <br />under Section 3002(b) of RCRA, I also certify that I have a program In place to reduce the volume and toxicity of waste generated to the degree I <br />have determined to be economically practicable and 1 have selected the method of treatment, storage, or disposal currently available to me which <br />minimizes the present and future threat to human health and the environment. <br />Printed/Typed Name <br />I ature Month Day Year <br />T <br />a <br />17. ronsporter 1 Acknowledgement of Receipt of Materials <br />M <br />Printed/Typed Na <br />SI Month Day Yeer <br />Is <br />7"•J <br />0 <br />13.Tronaporter 2 Ackn wledgement of Receipt of Materials <br />A <br />T <br />Printed/Typed Name <br />Signature Month Day Yeer <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />1.. <br />L <br />1 <br />T <br />r <br />20. Facility Owner or Operator. Certification of racelpl of hazardous materials covered by thismanifest except Item 19. <br />PrtnledRy Name <br />Signature onto De Ysar <br />ia- <br />EPA 3700-2/35) YELLOW: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS ENuP pCjVV SEav �G�J <br />1 <br />