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Stare of Califomio-Em,vonmenal Ratiction Agway <br /> Form Approved OMB No.2050-W39 EVnes 9-3096) 4111111� See Instructions on back of p_ 6. Dnt epartmeof Ta k Saba Central <br /> Ple.print or type. Foran d.,.d for ve on.0.(12,i h)yperrilw. Sacramento,Califomio <br /> UNIFORM HAZARDOUS I. Genme"a/,US EPA I No. Manifest Docummt No. 2. Page 1 Informatian in"shaded areas <br /> WASTE MANIFEST a o 6 Z / y 4 S q of is net squired by Federal law. <br /> 3. Ge erateri Nome and Mailing A MarmTwl'DryctmneiN 3 <br /> C rl L N cl =n} <br /> w „ st i kA � �A 9S3%c <br /> �+ a -e:stare Generators ID <br /> 45 <br /> 6. Gemstar,Phase LL k6)/ p 3 t! ro a r I <br /> t <br /> 3. Transporter 1 Company Name 6. US EPA ID Number C. State Trsmpornves ID <br /> i <br /> D. Trmsporter`,Pham - <br /> 7. Transporter 2 Company Name R. US EPA ID Number j E. Stan,T,amporters ID <br /> Q F. TrmsporteJs Phone <br /> LO <br /> 9. Designated Facility Name amd Sia Addrm, 10. US EPA ID Number G. State Facility's ID <br /> N _ . <br /> V-4v_ H. Faciliy's Pham-^ <br /> _ .-." <br /> Z 11. US DOT Description(Including Proper Shipping Name,Hazard Claes,and ID Number) 12, Containers 13, Total U. IANC <br /> No. T Wf/Vol J. Waste Number-:" <br /> ) C <br /> O.�VJA/- �r 'C ft /-r��11..f3K.�'J:/.J L✓-f$TxT SOIL y� a��DO -1p:' pose `e <br /> „ t <br /> c R f ASSOC;o-_ :) fl:�NC� &I <:-.1 `� A Other <br /> E <br /> R SPA/oMer <br /> TC. Stab <br /> go <br /> O <br /> d, R =FPA/ONwr <br /> W <br /> Z d. <br /> W <br /> W <br /> N <br /> W <br /> of <br /> Q <br /> Z <br /> 0 15. Spacial Handling Inshstciiau and Additional Irdarm stion _ <br /> P r , <br /> 16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contorts of this comignammt aro fully and accurately described above by proper shipping rase and aro dossified, <br /> Upocked,marked,and labeled,and aro in all respects in proper condition for transport by highway according to applicable international and national government regulatians. <br /> -� If I am a large quantity generator, I certify the I have a program in plane to reduce the vakrme and toxicity of waste generated to the degree 1 have determined to be <br /> F6 economically practicable and Nw at I have selected the practicable method of treatment,eorogs,or disposal currently available to me which minimizes the present and future <br /> Nthreat to human heath and Nw erwirormenn OR, 9 1 am a small quantity generator, I haw made a good faith effort to minimize my wast generation and select the best <br /> waste numagenterm method than is available to me and that I can afford. <br /> } Printedjyp.d Name C r L Signature % /ft N� ,Abrnth Day yYear r <br /> U �'f t <br /> W o17. T o 1 Aekr vied of Receipt of Materials <br /> A Pnmd/Typed Name Sigratum Monsh Day Year <br /> O N <br /> W S <br /> yFj 018. Tromparlie 2 Acknowledgeessent of Re,om t of Mrmriub <br /> W Primed/Typed INmne I igmNre MONK Dal' Yea <br /> F r <br /> A <br /> ILI <br /> V) 19. Discrepancy Indication Spxe <br /> U P <br /> A <br /> Z I <br /> 1 <br /> L <br /> 1 20. Foci Owner or Certificationof recei of hazardousman,rtoh cornered by this manifee as sated In Nem 19. <br /> T PMed/Typed None .SigaNre Month Day Yaar <br /> r <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC SMA (1/93) Yellow: GENERATOR RETAINS <br /> EPA 6700-22 <br />