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Sam of Calffomia--Envmz memal Protection Agency <br /> Farm Approved OMB No.2050-=9(Epi.,9-30-96) See Instructions on back of page 6. Deperm„nt of Task y,n,mnre,c, <br /> P1eau Print o[type Fame designed For use on elite(1217y ewndm. Suranento,Cahfomia <br /> UNIFORM HAZARDOUS Generator,US EPA ID No, Manifest Docum2. Page 1 nforseation in the shaded areas <br /> _ is not sequined by Federal low. <br /> WASTE MANIFEST f. L it i t C 1 7 9 51 18 9 err t <br /> 2. Generators Name and Moiling Address A. Slob Al erufe,t Document Numhar <br /> 9665 <br /> 6 r(^* C o 9 <br /> - . 0., BI . c 1 t. ;.. I F�..p•,[ , , �.,�. - 4..,F3 s- ;', �7 G+ a J J .7 <br /> N R• Stale Germs a,'.to <br /> � 4. pessimism's Phone ('.j 1 •). .i a Y-. <br /> 5. Transporter 1 Company Nome 6. US EPA ID Number C. Stake Tromporters ID <br /> D. Transporter's Phone <br /> (. 1.1`3.1�,F•?—E{y j.i <br /> < 7. Transporter 2 Company Name 8. US EPA ID Number E. Status Transporter's ID <br /> U <br /> '..f a I I I I I I I I I I I 1F. Transporter',Phone <br /> Z 9. Designated Facility Name and Silt Address 10. US EPA ID Number G. State Facility's ID <br /> Go M0 <br /> RI`ll_F'I1 1 I ,.. tris � !J'. . <br /> �,� = -."J Fst 1'. - FI. Fmirrlt/,Phone <br /> in < SIi-.VEP r- M fgla`-. I.I'_; yq,g_„-s t - <br /> A Z 11. US DOT Descriplion(including Proper Shipping Name,Hazard Gan,and ID Number) 12. ntainem 17. Total 14. Unit - <br /> W No.CoT Quantity Wt/Vol I. Wine Number <br /> S atgry <br /> �3 NON-PCF:A HAZARDOUS WASTE LIG!UTG <br /> G- f kiATER w -SLUDGE) _ i 01 T T G EPA/Other <br /> o E <br /> emp N Is. State <br /> i E <br /> y R <br /> A EPA/pMr <br /> bbsi <br /> T C. Sae <br /> O <br /> W R EPA/Other <br /> Z d. <br /> w State <br /> U <br /> M EPA/Other <br /> OJ. Additional Descriphom for Materials Listed Above K. NOWN11grp Code,for Wasps Listed Above <br /> U TA14K LiCiTTGM WASTE a. b' <br /> a PINSATEC. d. -- <br /> r Z <br /> Q 15. Special Handling Interactions and Additional Information <br /> a APPP,OPRIATE PROTECTIVE CLOTHING JOB SITE: <br /> Z "EMERGENCY CONTACT: 42EQ4Fr; 669241 4/4) � 7� �(pf/a 45 E. HARDING WAY <br /> SEE E.R. G. -2f jqj STOC:K,'TON, CA <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping assets and aro classified, <br /> < packed,marked,and labeled,and an in all respects in proper condition for transport by highway according b applicable international and national government rogulotians. <br /> I U <br /> If I am o large quantity generator, I certify that I have a program in plain to reduce the volume and bxiciy of warm generated to the degree have determined to 6a <br /> y economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> threat to human he shh and the environment;OR, 0 1 am a small quadtty generator, I have mode a good faith effort to minimize my waste generation and select the bed <br /> 6' wash,mane emenl method that is available to me and that 1 can afford. <br /> O Printed/Typed Noma Sione'm / Alael Dey Yaar <br /> L v ✓. Z <br /> W T r 1 Ac of Racal of MaMbls <br /> A Prirnted/iyped No SipnoNn Menlh Day Year <br /> = OE PUETT <br /> R IB. T r 2 Acknowled st RaW of Malxfals <br /> 002 U2 I? <br /> U. T PrMted/Typ d Nome n <br /> Q Month Day Ywr <br /> R <br /> y19. Discrepancy Indication Space <br /> U IF <br /> A <br /> [Cl <br /> 20. Foci' Owner or rator Cerd/icotion of..lot of hazardous material,covered b this nwnifed su m noted in Rem 19. <br /> 1T, SipneN <br /> Printed/Typed Name rs Month Day Year <br /> DO NOT WRITE BELOW THIS UNE. <br /> OTSC 00—T7 w(1/95) <br /> EPA 87700.- YelloGENERATOR RETAINS <br />