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State of Colifamia—EnvirenmentaF Protection Agency <br /> Fors Approved OMB No.2050-0039(Expiro 9-30-991 See Instructions on back ( If�e f7�� Sacrom. Dapartmeot of cromeanx:c Substances CannotPleow printor types Farm designed lar u»on e67e f f&pireh) pewriter. ro,California <br /> 1. Generalists US EPA ID No. Mae:fest Documents No. 2. Page I Inkrembs n in rhe shaded arws <br /> UNIFORM HAZARDOUS trio equiredbyFederal law <br /> . <br /> WASTE MANIFEST 0 6 of <br /> 3. Generate/s Name and Mailing Address F$4A;y-tt <br /> OLy�,P•pA/ SCrJK� Sfae OA) <br /> litK Awed _ hrrS 'in AV RO <br /> 1. Gen eraror's Phon <br /> e 1 C/9 G <br /> N 5. Traropomr I Company Name 6. US EPA ID <br /> h Number - <br /> !CT <br /> akr%4aq <br /> c ASBURY ENVIRONMENTAL SERVICES �� t. •-�t_3s)ee6-a+e0 <br /> m 7. Transporter 2 Company Name 8. US EPA ID Number SbteT <br /> °.m.aaxs+ <br /> Q <br /> U 9. Designated Facility Nama and Site Address 10. US EPA ID Number G t?RT-l7`kq <br /> d DEMENNO KERDOON 13�Q <br /> Z 20 gn RABA�is �t� 04 L !F FsHisy_s Phone .- <br /> No r „�. (310)337-7100 <br /> M= 12. Containers 13 Tom( 14 Un.t <br /> U 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Oumny Wt/Vol 1. Wade Number <br /> O Z Sto <br /> NON-RCRA HAZARDOUS HASTE. LIQUID L <br /> 003 G (HATER,DIL) No Placard Reouired T eIe , ^ EPA/Odea, <br /> NOW <br /> E�o <br /> N b se. <br /> m E EPA/Other <br /> e R <br /> a A <br /> T c Grote <br /> / <br /> so O � �N EPA/Other <br /> R <br /> w d. 'taro <br /> F 4 <br /> U 1 EPA/Other <br /> non Dncrtpbene <br /> a , <br /> H <br /> s rT <br /> � 4 <br /> 0 15 Special Handling Instructions and Additional Information <br /> Z OS.OV63 L gOggLL9 EXERG.ENCY CCNT.LCT:MEZ HARPER (310)3137-14-',3 <br /> W <br /> H <br /> r 16. GENERATOR'S CERTIFICATION: I hereby Globi 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 applicable international and national government regulations. <br /> If I am a large quanfiy gansrasar,1 certify that I have a or. ram in place ro reduce the volume and roxiciy of waste generated to the degree I have determined to be economically <br /> o_ prodlcable and that I hme ulaaed the praaic.6b method nF treatment,storage,or disposal currently available to me which minimizes the present and furore threat to human heaith <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 the best waste management method that is <br /> d' available he in.and that I can afford. <br /> OPrinted/Typed NT. 'y is r — Signature - Month Day Year <br /> Z (/ <br /> W T 17. Transporter 1 Acknowledgement or Receipt of Materials <br /> w jPrinted/Typed Name - _ Signature I Month Day Year <br /> W 0 18. Trans otter 2 Acknowsld amen of R. t of Materials <br /> O E Printed/Typed Nome Signaldre . Month Day Year <br /> uW F v <br /> R <br /> U19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> l 20. Facility Owner n0ponmor Certification of race( t of hazardous materials Gavard 6 this manifest except as noted in Isom 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 />