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AUG 24 '88 1317 G00DYEAr 'IISTR SVCS <br /> ;tate of CA,,iotnla—Health and Walters Agency <br /> Department s Health Semites <br /> 'Maas print or ype. (fern designed lot use on eros ry?- /fen Toxic Substances Control Division <br /> P 1 rypewnro"1 <br /> UNIFORM Sacramento,Callfo(rua <br /> HAZARDOUS . 1.Geherato('s US EPA ID No. Manifest 2. Pepe 1 infcrmalidn In the shaded mese <br /> WASTE MANIFEST 7 Document Nv. I3 not reQul(ed by Fsd@ral <br /> S. G*AeratO('e NUM and Melling Address of law_ <br /> Goodyear Tire & Rubber Company M"fast <br /> a. asjj$QF%tQA1 P9902209-464-9481 Dtdoum� ant.Nuotb.,� <br /> ._r.., <br /> S. If aponer t Company Nams e_ �• U9 EPA ID Number <br /> 7. Transponer 2 Company Name e. US EPA ID Numesr <br /> t. <br /> Designated Facility a;Pntma "r • •lt,.:::..... . . <br /> Y Name eM 91u Adarsea t COI US EPA 10 Numoer a10 R�• 9 - r: y <br /> American Environmental Mgm p, <br /> 11855 White Rock Road ; <br /> Rancho,Cordova, CA 95670 <br /> 11.US DOT Description(IntrudingProper Snrppmg Name, Hazard C/ass,and ID Numoer) 12.ContalneIs 13.^ 14, - ,< <br /> Total UnitI•, <br /> a, NO. Tyra Ouantlty Wtfvoi Wansi'HM, <br /> Hazardous Waite Solid N,p. S.ORM-E NA9189 /� ""� '`� <br /> o. ;. 4. <br /> C. <br /> d. <br /> a. <br /> �'� rn• '4 r <br /> v1lro{ <br /> J: Additional ONcrIP11oM fpr Materials Uetad Above ; <br /> ,3 GIOOO6 far Wanes Uated Abo" + ,.. <br /> 13.Special Handling Inatrucuone and Additional IntormUlon vhf i. <br /> -�06 f�>1�1 <br /> 14,MEMTOWS CERTIFICATION:I hereby declare that tM tomenta o!IDle consignment are fully and accurately described above by <br /> POPS shipping Mme and are Classified•backed,marked,and labeled,and are In all raapecte In proper Condition for Iprtransportby highway <br /> aeepolrp to applicable InlefMtlonal and national government regulations. <br /> Unless I ons a small Quantity gehefatW who has MM expmpled by statuto or regulation from iM duty to make a wasle mmimlxetlon cenalcatlon <br /> haps Sectioetermin 3002(0) of RCRA.economically <br /> I oleo cattily that I have a program In puce to r M the vmume and to:icltY Of wool* gerrofated to the degree I <br /> nava IZOS the <br /> to M econemiceily prectl=10 and I have selected the matho of treatment, storage, s disposal currently available to me whicn <br /> minlmlHe lM resent aM future threat to human health and the environment. <br /> dnted/Typod Name <br /> gna ,( oar y ear <br /> 17•TreMponer 1 Acknowl ooment of ilecerpt GI Matarlpls <br /> Print I yped e D ' <br /> / Mench y ar <br /> $TraMp 2 Acknowledoement of Reulpt of Materiels "' / / <br /> Pdnteor1ypad Name Signature <br /> Menfh Day YN( <br /> it.Discrepancy indication Space <br /> 20.Facility Ownef or Operate,: Certification of receipt of haW(deus materials covered by this manliest except as noted In Item 19, <br /> Pllffladflrygisd Name Signature <br /> M*nrn Day year <br /> 9022 A(I Ire5I Blue GENEPATOR SENDS THIS Mpv Tn nnuc WIT"'M In X111 <br />