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❑te of California—Environmenfal Protection Agency <br /> rm Approved OMB No-2050-0039(Expires 9-30-99) See Instructions on buck of (j, <br /> ease print or type. Form designed for use on elite 112-pitch)type Department of Toxic Substances Control <br /> z 195 Sacramento,California <br /> UNIFOL 1. Generator's US EPA ID No. Manifest Document No. 2 Pae I <br /> RM HAZARDOUS g Information in the shaded areas <br /> iWASTE MANIFEST is not required by Federal law. <br /> 3. <br /> 2 0 9 <br /> CAT0 <br /> 3. Generator's Name and Mailing Address 6 oftljocumeu <br /> �P7�/+�-y��-s Tk?4mber ' ��'`'}�[,.n,. <br /> y1141i:11.CJ�L:LJLI p�/yq� ry/y� 2- 19-5R-, N <br /> PO 5095 L[l1M 1#JL'JI O0 _ 4""7 at <br /> r.it'Sl�'I7IN (:A 94583 (!�� r r a <br /> d. Generator's Phone `eZJ )42 "4,& v <br /> e b. US EPA ID Number '" <br /> LO TIQN & 'tssa p _'ap let's{L1}Reseco <br /> RNNEX)IATION, INC. C A D O 6 3 15 417 91916 <br /> t pt yy d� #Y <br /> 460 1J[6 YGai. <br /> 7. Transporter 2 Company Name 8. US EPA PD Number s ter4 tf?„{Reseeved�s iA r +}"Itr 1 <br /> 9. Designated Facility Name and Site Address � 10. US EPA ID Number /��r <br /> Z !eGS ,G rTLr . r (IiLt <br /> 1 1. US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number{ 12. Containers 13 Total 14. U1.1t <br /> a_ No. Tye Quantity Wt/Vol ,xv <br /> Z <br /> BASTE FLANIKABLE LIQUIDS, 11.0.5.(GASOLINE, OISSKL), 3 OA1993 PGII <br /> E RQ (11018) UGI(128) 01011 T T I G <br /> N b. <br /> E <br /> _A C. <br /> 50 0 <br /> d, <br /> -._ `- •- -. .. ' .,. ,��°`�`r�� .,; to <br /> r. <br /> I5. Special Handling Instructions and Additional Information Y�� <br /> EMGUCT RKSFONSE CALL (800) 947-7701 <br /> PVIJ -�p51,1 <br /> 16. GENERATOR'S CERTIFICATION_ I hereby declare that The 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 all respects in proper condition For transport by highway according to applicable international and national government regulations, <br /> If I am a large quantiTy generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economicallyy <br /> Practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threol to human healtF <br /> and the environment-OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> available to me and that I can afford. <br /> Printed/Typed Name - Si fore <br /> Month [?ay Year <br /> s <br /> �� I i Ll f.l� Z c <br /> u T 17. Transporter I Acknowledgement of Receipt of Materials <br /> A Printed/Typed Na e <br /> Signature <br /> A 1e` Month Day^ Year <br /> L 0 18. Trans iter 2 Acknowled emeni of Receipt of Materials <br /> RPrinfed/T Name <br /> EE Yff°d Signature MonthDay Year <br /> R <br /> 19, Discrepancy Indication Space d <br /> tta—tt424�1YTf=@iv�N?rw�3cs�a rtU{p•��ruu\ir.� <br /> x`11C`J�C�.i1tSresT GcC Wf} 0Af]r <br /> f 20. F [i Owner or 4 talar Certificat on of recei t of hazardous materials covered b this manifest exce t as noted in It 19. <br /> T P" /Typed Name Signafur s <br /> Y r ry �! Month Day Year <br /> DO NOT WRITE BELOW S LIN 17/ 13r c <br /> U8700U8700 8022A (1/991 White- 15DF SENDS THIS COPY TO DTSC WITHIN 30 DAYS- <br /> -22 <br /> `-22 To P.O. Box 3000, Sacramento, CA 95812 <br />