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�1�1 Somb--Emironmmrd Praecnw Ays:ry <br /> Form Approved OMB No.2030-0039IE.,rsn 9-3o-96) SN Instructions on back of pc..rv: 6. Department of raxK sal,.taM..car»ra1 <br /> Pleme prig or type. Form de,,g to,erre an tet.(l1ylA[IQ typnw0. ti Sacramento,California <br /> 4[. UNIFORM HAZARDOUS 1 Cmm aim's US EPA ID'X. Manifest Dxument No. 2. Pape 1 I Information in the shaded areos <br /> I /1 n not required 6y Federal law. <br /> WASTE MANIFEST Q SZ '�� E 7 f of <br /> 3. Goo oars Noma and Mailing Address � O U � > A. State Modfeet DocumM Number 96844631 68 ` 463- <br /> IrO <br /> n O �C�` 9y37 e, B. State Generators lD <br /> „ 4. Gerrrators Phone (��)O� CJ — O <br /> S. Transporter 1 Company Name 6. US EPA ID Number C. State Tramporters ID `i• <br /> J <br /> ECOLOGY CONTRUL INDUSTRIES C1 AlD. Tragspurtse, ane <br /> V7. Transporter S Company Not 8. US EPA ID Number _ E. State Transporters I <br /> r F..Traapmiers Phose 3 v <br /> M Z 9. .CIDegpnaedF«ilitv1Naprl utd SRe Addren 10. US EPA ID Number G. Store Foriliiy's.ID <br /> 255 Parr BlVd. <br /> V Riduwnd,�M. 94801 C _ D 0 0 3 4 5 6 3 9 2 ifity"Phone (51Ci1235-13934 k <br /> 11. US DOT Description Total 14. Unit <br /> ���ssee Z Pito^(meludln0 Asper 567PM9 Nam,Hasard C1mt,and ID Number) 12. Containers 13. T <br /> �y = No. 1 T Wf/Vol I'Waste Number <br /> 3 a'NJI>HRCRA Hazar*ious Waste Solid M 513 <br /> l GWaste <br /> c E ESftEity Storage Tank fNb 0101i / L C p 'Pm N b. f <br /> f a E �, <br /> yR EPA/Other..-� :.., <br /> A « <br /> I pp T c• :State <br /> O <br /> fY R EPA/ONw,, .. <br /> 1 Z <br /> V -r§',. . <br /> 1 N ' <br /> W <br /> J <br /> a <br /> Z <br /> • 0 15. Special Handling Instrhrctian and Addtfoml Information <br /> Z Keep awav from sources of igniti }ways wear hardhats when w2rkina arc�lnd <br /> U.C.S.T. 's 24 Hr. Carttact N�m3l 1/ i P J' & e <br /> h W <br /> S <br /> F <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the commit1th of 1camignment are fully and accurately dscr <br /> eibed above by proper shipping mane and are classifed, <br /> U packed,marked,and labeled,and are in all respects aaim <br /> in proper condition for transport by highway according to applicable international and natiol goroment regula I.s. <br /> f If I am a large quantify generator. I certify that I haw a program in place to reduce the volume and toxicity of waste gemmed to the degree I hero determined to be <br /> I J <br /> y acommkally practicable and that I haw selected the practicable method of heament,storage,or disposal currently aroilable to me which minimizes the present and future <br /> N threat to human heahh and the amiromnent; OR, t I am a all quantity generator, I haw made a good faith effort to minimize my waste generation and select the best <br /> 7 wash managerisent method that is availoble to me and that I can aHard. <br /> Primed/Typed Name.- - Signature 1 - Mate!. Day Yee( <br /> Z 7 an 17. Transporter <br /> 1 Acknowledgenneat of Receipt of Materials <br /> APfd/T ped Nome _ ) <br /> 3 � /z97 ye Lam.. <br /> W 0 18. T 2 Adm of Regi of Materials <br /> TPrinted/Typed Name Signature, Mantle Day Year <br /> F <br /> E <br /> jI y` 19. Discrepancy Indkotion Space <br /> V p <br /> Z G <br /> r — <br /> P i <br /> E 1 20. Faci=Y= <br /> rant Ceraicaton of recti t of hazardous materials cc,mmd b this manifest exc as noted in Nem 19. <br /> / SigmNre Month Day Yaar <br /> T <br />[S- - DO NOT WRITE BELOW THIS LINE. <br /> k DISC M2A (1/95) Yellow: GENERATOR RETAIN5 <br /> 1 EPA 8700-22 <br />