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CSRN 02 '919 17:09 EFICKSON I 415-335-3709 F'.3 <br /> Waved DMP No.2060-0030(ExPlres P3G01) ►J C..•Soa InStruCtlonn on Back of P1� Department of Health Services <br /> ,e Odin or lige. (FOrm deatgned for us*on alga(1E•p p•xvltoo, and Front of P Toxic Subwfancaa Control Divlalon <br /> aQa Sacramento,California <br /> UNIFORM HAZARDOUS i• nanerobr•e us EPA ID No. Manueat E. Pap• 1 <br /> WASTE MANIFEST Doeam6nt Na. Infplmetlon In the shaded areas <br /> la not required by Federal law. <br /> 3, Oenerpta' Npme and Me11Ing Addrou <br /> FRlk 1G{7r 114y 7`1%V 1< Aly✓iE A.'81d'Manu. x m <br /> 3131V14V`� D ' 2 , <br /> 4]6 at�� i a t ti( CA 9��0 B. at.t.Beneratore 10 <br /> PnOne( <br /> 4. 1 ) _ <br /> 6. Tronaporter 1 Comogny Nacos 8. U8 EPA ID Number ' <br /> any C.Bate TrAnapoder'a 10 <br /> on—Lig-Z <br /> D., Tronepone p Pfwne �T• T/anpponar y Company Nema S. US EPA ID Number <br /> Q.&Ate TnnapOrttn'a to <br /> al F.Transportarp Peon. ... <br /> 0. Designated FaclNty Noma and She Address 10. U9 EPA ID Number 'a. State FaclOyy,10 <br /> '091CKl6v /AfG <br /> 41(40AIV �kl� N. Fadap's Phone'. <br /> 1I. US DOT D064rlptlOn(Including Proper Shipping Name,Wzard Class,and ID Number) IE. GontaNera 13. Total 14. R <br /> a�a Duantity Unit Wpp(g NO. <br /> r3 �� 1 No. 7y0a <br /> a, W AJr� 15 MPT`/ S`�e(AG'I� �AA!!1 wtrvpl state, <br /> e c(.A L I rGb d=Nr p( �T�C <br /> N G✓AS7 On/ C j/ , EPAiothw <br /> }., <br /> F D. <br /> w R <br /> A state <br /> T <br /> t�v 0 FFA/ghaf <br /> Ptata <br /> rr EPAJCaw <br /> �7 d. <br /> State <br /> W EPAlOUror <br /> y J...Addllhnel DowiptWnp la A4tedalq y.tetl.ApoW - <br /> Sri 1C:.HAAd3ng COdee for Waetee Lletod Above <br /> W 1cA wirW 10:Apr_ VOTy /Cm P�✓L d. <br /> 'J000 �i1,4 7(_..1-e, <br /> t6. upeclal Menellnp InanuetloM and Adollbnal InPormytlon <br /> Is. <br /> Ind are TOB'S CERTIFICATION: <br /> stalk 1 hereby declare that the contents Of Int•conalgemant are fully and accurately described drove by proper shipping name <br /> end u•government regufa maraud,and labeled,and are In all r030acla In proper condition for transport by highway According to appllcabip Inleredlonal and <br /> national government npula110na, <br /> It I am•Large quantity generator,1 O.dlly Ihat 1 have a program In place to reduce the volume and <br /> to be AOOAOmlcayy practicable and that I have saleeted the praoticable method of Ir9alm•nt,eters .,or die oast curt neroted to the degree I have determined <br /> ptOuent erg tutors threat to human health and tits envkonmmt;OR,if 1 em I smell eatm Available to me which minimizes the <br /> generation end select 1116 beat wash management method that Is ave1461e to me and that genera <br /> pl r,1 nav made a good effort to minimize my weals <br /> Printec/Typed Name Slgnaturq <br /> tl i r'^ cr Month Day Y.at <br /> R 17. ranaDortar 1 Aokn wtedgement ct R.Oetpt of Matsdala l <br /> N Prlated/TyOed No 81 <br /> F �� d gna Manor Day year <br /> U tB. TranapONW E Acknowled a ant of Racal t of 1' <br /> g D Ataledala <br /> TPnnt•dlTypad ams <br /> E Slpndwa MOnth—3-yY-1 <br /> to. DLacrepe roy Md ealbn Bpaee <br /> F <br /> A <br /> c <br /> 1 <br /> L <br /> 1 E0. Feellhy nsr OI Operator CwrtiO /tun of raeel0t or hazetdpue maMLaLa covered 1 nlleat except As not d N Ile 1 . <br /> r <br /> y Print y d Wore Moral <br /> Monln pay Y <br /> 6 BQEE A if ) <br /> 37006-22 White: TSDf SEND <br /> EE DoNot w This Line WhCOPY TO DOHS WITHIN 30 DAYS <br /> v, Pr6vlcua edltlon•are OOaOLate. <br /> To: P.O. Boz 3000, Sdcraltlento, CA 95812 <br />