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Stale of C9klo.....Em a :Md Is 1010 Agency See Instructions on backypage 6. Ds ornn.m a/Te.r s bao,c..Ca . <br /> form Approved OMS No.2050-W19(Espana 9.7096) `� Sacram ,Cahfc,: <br /> pit.p..t a type. Form downed for.m Bite(12,;")bPM^M <br /> UNIFORM HAZARDOUS 1. Gwrraera US EPA I No. _ Marefest Docula�ll No. 2. Page 1 Idomation a the shaded areas <br /> y / [� aro aWi ed b Federal taw. <br /> WASTE MANIFEST C Q 0 / Z �, Z `f S I I of If <br /> 3. Ge wa`ar tNcros and Mdliag Adda's <br /> 1C 'v U r'S c 'iii <br /> h A. Gerrralors Pharr `)/ <br /> 3. Tranporta 1 Company Name 6. US EPA ID Number Sax _Lra a'Y® <br /> W, <br /> 'N <br /> Mi. h <br /> J <br /> a 7. Tnevporlar 2 Company Nome 8. US EPA ID Number <br /> 6 <br /> z 9. Designated "" <br /> Fadl' Name and Sib Address 10. US EPA ID Number <br /> vx A <br /> N o _ <br /> J <br /> V 12. Coreatnen 13. Tool IA. Unit <br /> Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Numbed Na Type Quantity Wt/Val <br /> ,14,it1J,:�< STSIS <br /> G V <br /> E4 E .f r�SSOC. ,= _.-. :� 1. � ..✓C7 . <br /> m N b. <br /> w E <br /> i <br /> a R <br /> mTG <br /> a R <br /> W <br /> Z d' <br /> W <br /> V <br /> W <br /> d <br /> N <br /> W <br /> W <br /> J <br /> O 15. SPedai Handling Mhvelans and AddRf wA Information <br /> Z <br /> r <br /> 16. G@IERATOR'S CIEITIPfCATION: l hereby declare flat the contenh of Mn condom oro seat an fully and acnrately described above by proper shipping come and ore classified, <br /> Vpacked,marked,and labeled,and aro in all respects in proper,condition for lraapod by highway according to applicable international and national gowmmeM regulations. <br /> If I over a large quantity garreratar, I certify that I how a program in plan a reduce the v 4uma and tcmkity of waste generated to the degree I haw determined to be <br /> G <br /> economically practicable and the I haw xlecled the practicablemethod of treatments,Manage,or disposal currently awa ilable to mwhich minimizes the present and futare <br /> W threat to humor health and the enmom ant, OR, it 1 one,a small quantity gemratar, I haw made a good faith effort to minimize my waste generation and xlect the best <br /> K waste reasmagerment method the is owiiabi.to not and that I can afford. <br /> O Prated TY xd Mame signaturer — • March Day— Jeer <br /> � 1 I <br /> W 1 17. T m <br /> Transporter I Ackwlod of Receiptof Material, <br /> (� A Primed/Typed Name Signetare March Day Year <br /> R <br /> W< S <br /> ySj 0 18. Transporter 2 Ackmwkd enrim,of Receipt of Materials <br /> APrk ted/Typed Name n March Day year <br /> O [ <br /> A <br /> yj 19. Discrepancy hsdica cm Space <br /> < P <br /> U A <br /> 2 C <br /> I <br /> L <br /> TD. fadl' Owner or er <br /> Operator CwFcation d m <br /> receipt 0l hardaus material,covered rM this masilexcept as rated in Item 19, <br /> IPrkated/Typed Name . .Sytetare Manta DuyYear <br /> Y <br /> DO NOT WRITE BELOW THIS UNE. <br /> DISC 9022A (1/95) Yellow: GENERATOR RETAINS <br /> EPA 8700 n <br />