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Stare of CnliFomia—Emironmemal Protection Agmry •� <br /> Form Approved OMB No.2050-0039(Expires 9-30-94) See Instructions On back Of page b. Departmem of smask Substances <br /> roControl <br /> prim or type. Form designed for use on elite(12pihh)4pewnitru Sacramento,California <br /> ��r'sUS EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS ('a is not required by Federal law. <br /> WASTE MANIFEST 6 _. ar <br /> 3. (isearo se,Name and Mailing Address `A. Stare.-1... et Domment Num <br /> O <br /> rfj _` ff v' •' I B. State Gencrator's ID <br /> h d Gen2raror s Plranvr'e ('�': 1 {•x i " r <br /> 6. US EPA ID Number C. Stare Trump. er's <br /> ung$' S. Transporter 1 Company Nome _ <br /> Transpartcr's Phone <br /> M� 7 Transporter 2 Company Name 8. US EPA ID Number E. Score Transporter's ID <br /> W f. Transportels Phone <br /> 9Designated facility Name and Site Address - 10. US EPA ID Number G: Stare facility's ID 7 <br /> �Q . esgnaeacf <br /> Q� 1 I` � t T � M Fac l y s Phone <br /> U 12. Containers 13. Total 74. Unit <br /> Z 11. US DOT Description(irduding Proper Shipping Name,Hazard Class,and ID Number) No T Goan Wt/Vol oste Numb,_ <br /> E 1F:B, lc' I i <br /> 3 .roll r ;�.:� i{ v ,.1"�rTsl. {T'Y.,Fy � t't-� <br /> G rl <br /> cher <br /> r E n <br /> N b. , <br /> go E <br /> NR CMher. <br /> T C.00 <br /> . idte ^i <br /> O <br /> ^ R iPA/Other <br /> IM <br /> Zd a 9rare <br /> us <br /> Ctfher <br /> W i I <br /> Z ' dFCti6I3' (t"Sdpndlutg Yat es:for axles lista .A we <br /> 0 15. Speoinl Handling Instructions and Additional Information <br /> t— 'K-ar P.P.E. ( f rt.T)JIIFT y4„ r blFs- lsp=:)f -I�r7 tli �RtPi.REreCS- Zo`,�.ellhonet; <br /> Q <br /> pro tert I% P CZ!: t!; .li'�i . ipt:s.l t.�,,� . ,.� as ( �. . Pi?1-41, r` <br /> Z <br /> _ Tura ; !;? p Ft.^ Of5-2t?(TZS <br /> 76. GENERATOR'S CERTIFICATION: I hereby declare that contents the consignment are fully accurately described above by proper shipping nam,and aro classified, <br /> J <br /> Q packed,marked,and labeled,and are in all respect in proper condition for transport by highway accordir6 to applicable federal,state and imemational laws. <br /> U / <br /> If I ons seminarian,a large quantity seminarian, certify that l have a program in place to reduce the volume and toxicity qt waste generated to the dve degree I haderma fined to be <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal cur m y available to me which minimizes the presets and future <br /> threat to human health and the emiromnent;OR,if 1 am a all quantity generator,I.lu ve made a good f16 effort to minimize my waste generation and selectthe best <br /> N <br /> ement method that is awilabla nrs and Ilial I can afford. <br /> O Printed/T N9me ,« / Signature ,? , ."nB).' Day Year: <br /> Z T 17. T r 1 Acknowledgement of Recei MalerlaR <br /> W <br /> Printecl/7ya.4 Name ,I f1 J Sign stu f(wrNy Days /Y <br /> W e �J ,l V i I �eii L_ CJ,. <br /> 1 v <br /> 0 18. Trans r 2 Acksmwled emeM of Receipt of Materials <br /> W T PriMed/Typed Name SigmNrc �,/ Month Day Year <br /> W <br /> O e <br /> W 19. Discrepancy Indication Space <br /> U F <br /> U p <br /> Z C <br /> I <br /> L <br /> I 20. Facility Owner or Operator Certification of receipt of hazardous materials covered b this manifest except as noted to Rem 19. <br /> P T Printed/Typed Name Slocten Month Day Year <br /> Y 7]n�s}h�/!011>W O &17-1 51171-q <br /> DO NOT WRITE BELOW THIS UNE. <br /> DTSC 8022A (7/92) r._.._. ueni co ocruuc <br />