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Stete of Calllamb—En.irenmwval Protection Agency %.I <br /> Form.Approeed OMS No.1050-0039(Eepirrs 9.76961 Seo Instructions on back of page 6. Depanmem of Took Subdancm Cer <br /> Ppae prim or Type, form designed for um on dib(f7gPch)rym-M.,. Sxramwue.C.6famla <br /> UNIFORM HAZARDOUS 1. Generator's US EPA 10 No. Mandssf 0o u rM W. 7. Papa I nlormodon In the hated greet <br /> Is not rm:nAmd by Federallaw. <br /> 0 <br /> WASTE MANIFEST CAC 0 0 0 7 6 3 4 4 1 I1 3 7 1 1 of 1 <br /> '3. Generators Name and Mailing Address A Starr.Mardfat Documem Numbers^ <br /> $ PIEDMONT LUMBER <br /> n 7777 W, ELEVENTH ST 'TRACY, CA. 95376 R stat.Gesdraa A ID r A!I, <br /> 209 943-7793(NI 'p' �+ 1g <br /> •0 l Generator's Phone r♦Lry - •• - '- <br /> S. Transporter I Company Noma 6. US EPA ID Number C. Sfate Tranepenal. <br /> O. 7_'­"61 <br /> raapom - 1 •.'` <br /> Ira <br /> B.O.R. INDUSTRIES CAD 1 0 2 8 2 7 5 9 9 Ph.ne 916 372—'2342 <br /> 7. Transporter 3 Campmry Name S. US EPA ID Number E Slat Traupartet'/10?n; '3"�A�rr X? « <br /> k �,� 4 3 <br /> �' U P Trumpets.,'.Phan `;.IV.r4;-PIs r <br /> Q ` 9. Designated Facto Name and Sift <br /> Address 10. US EPA ID Number G Sial.FtsdNyl IDn IFe?�,rye t+ F`'« <br /> Ct 2 Ty J L <br /> PRC PATTE2SON <br /> L13331 N. HIGHWAY 33 H. FucRily'.Phone <br /> O PATTERSON, CA. 95363 CAD 0 8�3 1 6 6 71218 <br /> (800) 87414444 ; , <br /> (� <br /> 11. US DOT Description(including Proper Shipping Name,Harvard Clad,and ID Number) 17. Containers 13. Total 11. Unit <br /> 2 Ne. T Quant Wt/Val lWanks Number <br /> NON—RCRA HAZARDOUS WASTE LIQUID <br /> H E OIL, WATER, SLUDGE 0 j0 11 TIT 7 G <br /> m N b. <br /> EPA/ORdr,� <br /> yya A <br /> CJ <br /> TC. <br /> c0 � 9'iar F <br /> O �A/ . ..'��•��.` <br /> oc R �y Sas <br /> W d, <br /> ' <br /> U EPA/pq,.r•. <br /> 47 <br /> Zn J. Additional Descriptions lar Materials Listed Abate 7 ♦ ¢ rcw•{ tlr :r,R, 14,HmdOng Coda la WeeNs Listed Aheee <br /> d t yk <br /> ate ,.'f'tthf <br /> C. d. f "'7 <br /> O `.. <br /> IS. Special Handling Irulmdons and Additional Information <br /> i WEAR GLOVES & PROTE ,�T��G <br /> Z 24 HR. EMERGENCY It ( 8 <br /> W <br /> F <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare Met the cement,of this consignment an hilly ad accurately described above by proper shipping name and an classified. <br /> 'uuladau. <br /> A packed,marked.and labeled,and an in aR respects in proper condition ler transporttransportby highway aneardirp to appikable inlerrrorianol and nadersd government reg <br /> U <br /> _r II i am a large quantity generator, I ."Ify that I have o program m place to reduce the vdume and Ioeicit,of waste generated to the degree 1 iww determined to be <br /> economically practicable and that I haw selected IM proctbable method of treatment,slwege,or disposal currently mailable to me which mhwnlses she present and future <br /> W threat to human health and the.mwomMnr,OR, g 1 am a woo quantity,ge tmaksr, I have made a good faith effort to minimize my works generaaon and select she but <br /> ac wade management method that is available to me,and that I can afford. <br /> 6 Prinbd/Typed Name SI VIWMonth Day Year <br /> _ _ 0 16 9 <br /> Z A 17. Transporter I Acknowledgement of Ressipt of Materials <br /> W A Printed/Typed Name Siptw , Montes Day Yea <br /> P <br /> g1 0 id Transporter 7 Acknowledgment of Receiptof Material'0 i hinted/Typed Name Signature month Day Yee <br /> Q [ j <br /> A <br /> pj 19. Dismpanry Indication Space <br /> V IF <br /> A <br /> Z C <br /> — 1 <br /> l <br /> i20, Focilby Owns or Operand,Certification of.*lot of haxardour materials covered by his monitor ea< I as Treated in It.. 19, <br /> T Filded/Typed Name Sigmonue Morris Day Yeo <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> `/yhirn: TSDF SE14DS THIS COPY TO DISC WITHIN 30 DAYS. <br /> msc laPls, 0 tom To P.O. eon 3000, Saaamenro, CA 93812 <br />