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4 <br /> FormApproved OMS No,2050-W39(Expires 9J096) See Instructions On back of a 6. <br /> PleaseP type. Form designed for u»on elite(12pifch) liter. r 9 Departortnt of Loxk Substances,Cor <br /> _ Sacramento.California <br /> UNIFORM HAZARDOUS is US EPA 10 Na. Manifest Dacument No. 2. Page I Information in the shaded ones <br /> WASTE MANIFEST /fr % f ✓ b J r f (, J a not required by Fads d law. <br /> of f <br /> C 3. Generolor's Name and Moping Address ,. r n <br /> vuli f%^`{�r�1 ./.%. jv/v r s,/L�+ (jam/ A. State Mmifest Docvnrent Number <br /> r ! <br /> It. Store,Generator,.ID <br /> W e. Generator's Phone 4--1 —.- <br /> 5. Tronspprter 1 Company Nam S. US EPA ID Number C. Stab Traaporws ID ' <br /> J 's•.>-x;•., 'Lt"' _ 't _, _, r 0. Transporser's phom ,. <br /> ,,,;u'E 74-4444 <br /> V 7. Tramponb 2 Company Nam 8. US EPA ID Number E. Stale TraapoMfs ID <br /> _a F. Trmsponei s Phone <br /> Z 9. Designated Facility Name and Sift Address 10. US EPA ID Number G. Stale Facility',ID <br /> Y :C i'n r.nS <br /> O= <br /> rI'„Y. C1 3 i16161712181 .; , <br /> H. Facility's Phone <br /> '-�-� V 2':�'i EXSC:. , i,., • `y.__ �: .� t 1 h i r 4— <br /> ..J - JUJ Cx. N4g4 <br /> `'v Z f 1. US DOT Description(including Proper Shipping Nome,Hoo,rd Class,and ID Number) 12. Containers 13. Total 14. Ilan' <br /> e x a. No. T Ou Wt/Val 1. Water Pluflaber <br /> 3 slat 223 <br /> M 4G NON RCRA tIAZA:RDOUS rASTI: ;.i QUID '- s- i EPA/Otiw <br /> m T_ ;, <br /> m N b. <br /> NE Stat. <br /> a R <br /> r5 A EPA/Odor <br /> ap T C. HflV3H1V1N3WN02llAN <br /> stab <br /> sic <br /> H R EPA/Odwr <br /> Z d. <br /> W Stale <br /> U <br /> W <br /> N EPA/alter <br /> 0 Z1. Additional Desc <br /> onaK. Handling Codes far Wastes listed Above, <br /> ul ssIs. <br /> J <br /> Z C. d. <br /> O 15. Special Haid6 Instructions and Additional Information <br /> a <br /> r4 iut. 1ERGri�CY CONTACT: PRC #1-(800)-874-4444 <br /> Z 24 HR. EHERGBNCY RESPONSE: CHEM TEL INC. U1-(800)-255-3924 <br /> x <br /> APPROPRIATE PROTECTIVE CLOTHING b RESPIRATOR. <br /> t- <br /> 16. GENERATOR'S CERTIFICATION: 1 hereby declare that the c(ntenls of this consignment are fully and accurately described above by proper shipping come and art classified, <br /> a packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> U <br /> .Jnr If I am a large quamiy generator, I certify that I hove a program in place to reduce the volume and toxicity of wash generated to the degree I hoe debrmi lid a be <br /> d economically practicable and that 1 have selected the practicable method of treatment,storage,or disposal currently available to me which minimizer the present and future <br /> U) threat to human health and the environment;OR, if I am a small uo I <br /> q ritity made a goad faith eNoH to minimize my wash generation and»bo the fed <br /> 0 waste method method l awilable b me and that 1 can afford. <br /> Preded/T <br /> Z T 17.—Transporter l Acknowle <br /> ARement of Reampt of Materials <br /> W <br /> (� A Printed/Ty Tep Sigaah, / ` j <br /> g<j Do, ,Ysep- <br /> 0. 18. Transporter 2 Acknowledgement of Recei l <br /> of materia / <br /> OE Printed/Typed Name Signahure <br /> R MathDoy year <br /> sn 19. Discrapaoy Indication Space <br /> U F <br /> A <br /> Z C <br /> 1 <br /> L <br /> 1 20, Faci' Owner or seasm,C 'fk ' of rearip,of mazardon precruni.l.revered W this m es a as noted in tarn 19. <br /> Printed/Typal Nam. / /)� / signmar. i i ma,n, Day <br /> 9i ' <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC SMA(9/9e) <br /> EPA 8700-22 blue: GENkRATOR SENDS THIS COPY TO DISC WITHIN 30 DAYS. <br /> 10: P.Q is— 400, Sucromento, CA 95812-0400 <br />