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Ao-991 See Instructions on back of page 6 D.Pa.mienlOf Toxic Sa6tances Cartrol <br /> r1 on elite(i2-pitch)typewriter. sacraasenb,Cafifornia <br /> HAZARDOUS I. Generator's US EPA 1D No. Manifest Document No. 2. P09d 1 Inlorwralion in*.shaded areas <br /> `� lfirdSTE MANIFEST a nal required 6y Ferferd law. <br /> 14411ctgdo � ` - ? <br /> alar',Nam,and Mallin Address404 <br /> }– k <br /> Genet/ 9 ci i � <br /> ,. Oerterafer`s Pham(916 1977--7777 <br /> S. Trnnsporeer 1 Cornpoey Noone 6.Us fPA 11)Num6er f l ' $1077 <br /> cglTtroles01310111713 <br /> . Transporter 2 Company Naive ' It. US EPA ID Nwn6er <br /> DeugrwMd Facrlrty Nome and Site Address 10. VS EPA 0 Number <br /> omit Chemin Corcwration M <br /> 208'1 Bay Road <br /> aPWOAlo CA 94303 61517 <br /> • .. -12- Cantoiners 13, Total - -14- Unit } _ <br /> 1. US DOT f)esvi rng Proper Sh-ipping Nome,Hazard Close,and 10 Nlrmberl � T Quantity */Vol v <br /> a-AeGJIYr37Z <br /> r -pool <br /> r. <br /> 4�. <br /> - <br /> al Handling Ins and A"S.pal Infor ion <br /> l�+ e r"prop- prise equipment handling. Weights Or vflltJMet irer #+j=, !?? <br /> 4 hour f mejgancy dumber. q'sG-` n- 7??719t,09"- 3TC- t_vC ATiON; h?aa�S7� Cs. <br /> 4 hour emergency contact;VC23s-�� 'E c-I <br /> L Geri 1~e .t-4-_ <br /> 16. GENERATOR'S CEITIHCAATICft I here6y'dsclare that the contents of this wd <br /> nrs Falfy and accurately described above 6y propel snry;g aoin+and are clowiKed,pocked, <br /> marked,and labeled,and are in all respech in proper condition for transport 6y l 91=according to apphco61e;n6fncdionol and national gwernmeni regofoliows. J <br /> d 1 am a forge quantity generator,I ccitify that 1 have a proVom in place so reduce the volume and toxicity of waste generated to the degree 1 have determined b 6s economicaNy <br /> prac,cal'is and that I have selected the dico6fs meltiotll of heohnent,slwags.or disposal curren+Fy oveilo6le b me which minimizes the present and h+9ure ITxwaf 10 human health <br /> and 11aa sm iromaaeM,OR,if 1 am a amaR quoniity genwWor,1 hate made a good Failte effort to minimize my waste genxation and solea tl,e best waste monoganent me"that is <br /> available b me and dbc*F can afford. <br /> Prinled/Typed Ffow+e Sigrfahrre - - Monter Day Year <br /> 1 H + iI at 10 O <br /> 17. trans 1 Acknowledgement o)Recei of Matertals <br /> Printed/Typsd Nama Signature Month Doy Year <br /> FSG y Q o �. <br /> 18. Tran 2 of Recai vF AAaterials <br /> Pdrr"ftyped Nome Signature Month 0oy Year <br /> 19.. Discrepancy Indication Spec. <br /> 20. Facili Owner or O rotor Certifimti—of r—i t of hazardous moteriols cowered by this manifest excwjgs noted in Item 19. <br /> PrinledAyped NameSigrsature Month Day Year <br /> �j <br /> DO NOT WRITE BELOW THIS LINE. <br /> t22A ll/99) While TSDF SENDS TH15 COPY TO DTSC 'WITHIN 30 DAYS22 To P O. Bog 3000, Sacramento, CA 95817 <br />