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...Stab of Colifemia—Environmensal Protection Agency t �• . l <br /> Form Approved OMB No.2050-0039(Expires 9-30-99) <br /> Pled»print or ype. Form designed kr wa on dib(72 pihh)y See IDB1ruc}10115 OA ifOCi( Of IT' d. DeparlmSacramento Substances Control <br /> r' J - Sacramento,California <br /> 1. Generator's US EPA ID No. Mancha Document Na. 2. Page I Information in the shaded..as <br /> UNIFORM HAZARDOUS <br /> WASTE MANIFEST C' �' J 4 , ✓ Z a no requhed by Faderol law <br /> r r � � <br /> 3. Generator's Name pond Mailing Address I - <br /> � r, 8802730 <br /> _ S. Sbte Generator's ID <br /> h ` ^� <br /> nA. Generator'.Phone(�fi <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C State Transporter',ID <br /> N <br /> C? ECOLCGY CONTROL INDUSTRIES 0 91812 0 3 0 1 7 3 D. Tramportels Ph.. 510-235-1393 <br /> 0 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E: Stab Transporte/s ID <br /> F, Transporser's Phone <br /> Q <br /> cVU <br /> ffNiN me and Site Address 10. US EPA ID Number G. State Fociliry's ID <br /> . AFP <br /> �a 255 PARR BLVD qs pp <br /> MZ A n • n x1 n ♦ H. Faciliyh Phone $�V'L JJ'iJJJ <br /> �O RiCHMOND, CSA 3480; A 0101 1 4 s o a y t i <br /> NQ 12. Conminen1 13 Torsi 14. Unit <br /> Q(1 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity WI/V.1 I. Wave Number <br /> COZ O store <br /> �X <br /> G Nan-RCRA hazardous waste solid + ;- �'`-=n ' ,r; P EPA/Other)?_$4E <br /> 3 <br /> o N 6' State <br /> as E <br /> R EPA/Other <br /> vA C. State <br /> o T <br /> W O <br /> R EPA/Other <br /> 1- d. scala <br /> Z <br /> Z <br /> s++ EPA/Other <br /> V <br /> w <br /> iti lion,for Materials listed Above <br /> EMP IYST0RAGF TAi¢iCi v ^' <br /> W T ANlC S)ttAU -R,TEO WIT <br /> a PER 10"611ILLC 'JS C <br /> Z NieprteEte rpPccdve elcfah awl when handling, SITE LOCATION <br /> Q 2A Hour CmorQonay Talaphana Nurnii" <br /> z 24 Hour Ernepency Ccnract: ERG# 171 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this Consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> Umarked,and labeled,and are in all respects in proper condition for transport by highway according ro applica6le international and nations, government regulations. <br /> IF 1 om o lar a anti eneraror,I cert; that I have a rom in lace to reduce the volume and toxic; of waste generated ro the degree I have determined to 6e economical) <br /> 9 q° y 9 rY ProB P H 8 e9 <br /> H practicable and that heave selected the practicable method r, treatment,aagostorage,or disposal currently available st g which minimizes select <br /> present and future threat ro human health <br /> and the environment;OR, if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select rhe bast waste management method that is <br /> d' available to me and that can afford. ' <br /> O} Printed/Typed�ame 1 ;f Signature e, r Month Day Year <br /> U <br /> Z <br /> W T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> w A Printed/Typed Name Signature Month Day Year <br /> R <br /> w L <br /> w p 18. Ticurseparoor 2 Ackncwled emenr of Receipt of Materials <br /> O T Prinsed/Typed Name Signature Month Day Yeo. <br /> N E <br /> Q R <br /> V 19. Discrepancy Indications Space <br /> F <br /> Z <br /> — p <br /> C <br /> . 1 <br /> L <br /> 1 20. facili Owner or Operator Certification of reasi t of hazardous materials covered by this manifest exu 1 as noted in Item 19. <br /> T Printed/Typed Name -Signature Month Day year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DISC 8022A(4/97) Yellow! GENERATOR RETAINS <br /> EPA 8700-22 <br /> i <br />