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amitate o{California—Environmental Protection Agency <br /> FIA. roved OMB No.2050-0039]Expires 9-30-99} See Instructions on bock of 6, <br /> ase prat or type:'Y=o7m designed for use on elite f l2 pilcbJ!yp p Department of Toxic Substances Control <br /> 6195 Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No- <br /> 2. Page ] Information in the shaded areas <br /> WASTE MANIFEST 9 8 is not required by Federal law. <br /> 1 CRT0800243008 2 O of <br /> 3, Generator's Name and Mailing Address to r <br /> C.r eMt Omen I mber PA=C FT47.T � <br /> PO BOX 5095, ROOM #3IIU00 k <br /> A. Generator's Phone SM RAMN CA 94583 � �• . <br /> { Z 1�i13-�f��b �» � ! r <br /> r3c <br /> 6. US EPA ID Num <br /> 1e��'ATION & uma r Res�eY f pv <br /> cp <br /> [4 <br /> K'F *+ tit L-s v <br /> R.QDIATIOdd, INC. C A D O 3 5 4 7 9 9 6 �' r � `° :a #' <br /> 7. Transporter 2 Company Name 8, US EPA!D Number s -4 ads e—e P <br /> -.� - fit- x ..y->✓.. ,� <br /> i 'l: <br /> 9 7 10. US EPA ID Number <br /> 9, Designated Facility Nome and Site Address <br /> 1 � l -L�• 4'� 1<-L L L T' i'5- <br /> 7FVa8:1l ;e <br /> 12. Containers 13. Total 14. Unity <br /> 1 1. US DOT Description(including Proper Shipping Name,Hazard Class,and]D Number] "-� <br /> Z a. No. T pe Quantity Wt/Vols <br /> _ HASTE FL,AMULE LIQUI©S, X-O.S.(GASOLINE, OISSUI, 3 U111993 PGII <br /> G R¢ (0018) ERG#(128) D 0 j T T b r O Lx G , <br /> qn0 <br /> N f,. P <br /> mno E ` <br /> R � <br /> CD T <br /> co O - <br /> R <br /> } <br /> J A <br /> 15. Special Handling Instructions and Additional Information <br /> 4 SlIEIfGB�Ci F&SPDl1SId CALL (804) 947-7701 <br /> 'tea CA <br /> -�+ <br /> I& GENERATOR'S CERTIFICATION: I hereby declare that ih.e contents of this consignment are Fully and accurately described above by proper shipping name and are classified,packed, <br /> marked,and labeled,and are in oil respects in proper condition for transport by highway according to applicable international and national government regulafions. <br /> If I am a large quanlily generator,I certify that I have a pr ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> practicable and that I hove selected the ppracticable method of treatment,storage,or disposal cu available to me which minimizes the present and Future threat to human health <br /> De and the environment;OR,if I am a small quantity generator,I have made o good faith effort minimize my eneration and select the best waste management method that is <br /> available to me and that I cue afford. <br /> Printed/Ty a Na. --- - Signature -- - - <br /> Month pay Year <br /> L <br /> D T 17. rens rte 1 Ack wled ement of Recei f of Materials o - <br /> R <br /> A Print yped me <br /> R ign re <br /> S Month Day J�Year <br /> PV <br /> It 18. Trans <br /> It <br /> a r 2 Acknow ement of Reeei t of Materials - <br /> Printed/Typ Name - <br /> E Signature Manth pay Year <br /> R <br /> 19_ Discrepancy indication Space <br /> A , ryyy- �' �r►e'�iF�.z,�Y Tact�;. -1 �„� �z f <br /> U Y`I 1 1rM1e7'r�l7 a71'Y ✓I / xh C <br /> 701 <br /> L :ULiAntil C, UJ 8 `^0'A� O 1g9S <br /> I 20- Focili Owner or Operator CertiFicotia_n of recei t of hazardous materials covered b this manifest except as noted in Item 19. <br /> YPrsnted/Typedt. Signaiur L MonFlt Day Year <br /> o L, <br /> DO NOT WRITE BELOW THIS LINE. <br /> �SC 8022A (1/991 White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> �q <br /> C8700-22 To: P_q. Box 3000, Sacramento, CA 95812 <br />