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M of ColiFornio—Environmental Protection Agency <br /> Approved OMB No.2050-0039[Expires 9-30-991 See Instructions on back of Department of Toxic S <br /> e print or lype. Form designled for use on elite f 12-pitcs ControlSacramento,Substances type. 195 <br /> California <br /> F1GTIF <br /> NIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page I Information in the shaded areas <br /> C A T 0 8 0 0 2 6 0 7 318 2 1 2 3 of 1 is not required by Federal law. <br /> 1AtASTE M�����A�N11��-�I""�FEST`+ <br /> Crlg AddressO. BCC 5095R!'lalk38 00CA 94583 1 dL - `M bbato(s PhoneLL <br /> V iS. US EPA 1D Numbers v 4, - <br /> h., S .mss.' . ' - <br /> �� r - r CAD063547996 <br /> T. Transporter 2 Company Name 8. US EPA 10 Number QW, _ . <br /> res <br /> NapFou nolagfes Name and ita s 10- US EPA Ip Number <br /> "�irv� en�a��chf <br /> z <br /> 2081 Hay Road <br /> F <br /> East Pala Alta, CA 94303 C A D O 0 9 4 5 2 6 5 7 + � 3e- 1538 <br /> 1 I" US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number[ 12. Containers 13. Total 14 Unit <br /> T <br /> IIdS FLAB LIQOIIISr I,O.S.(05011M, I}ISSlIL}, 3 01953 PGII No. Type Quantify wl/Vol _, amfser.. <br /> G R4 {Ii011} &ftG1{121} Q T T G grf�cr <br /> E '90 IGM <br /> N Nb. #ilg <br /> E <br /> R fl*A7ie' <br /> A <br /> v T ` STdne. <br /> m O <br /> R EPA/Other <br /> d. <br /> �taFe' <br /> Z _ <br /> W <br /> U EPA/Ofher <br /> -¢ ,a1_!� :4 rt h�a#` '- �trrij(t,Qrfesfd3Ms Fisted Aborti <br /> ii- <br /> Lu <br /> yy, <br /> 0 15. Special Handling Instructions and Additional Information -7�-7 <br /> BR IGM IIBSI'M9 GILL (800) 947-7701 '5 I rz-- + DOP-&55= V� I l � t'�•J 'S i. <br /> F- <br /> 16. GENERATOR'S CERTIHCATION; I hereby declare that the contents of this co"17ent are Fully and accurate 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 inlernolional and national government regulations. <br /> s IF I am a large quantity generator,I certify that 1 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 f have selected the practicable method of treatment,shxage,or disposal currently available to me which minimizes the present and future threat to human heallh <br /> and the environment;OR,of l am a small quantity generator,I have made a good faith @FFprt to minimize my waste generation and select the best waste management method that is <br /> avaiWe to me and that t can afford. <br /> Z Prinyptesd Name � Signator r Month Day Year <br /> Y`r1 V I "Z.. -Zp <br /> ll.l T <br /> 1I_ Trans rter 1 Acknowledgement of Receipt of Materials <br /> '1 R <br /> Printed/Typed Name - Sigrsoture _ Months Day Year <br /> S <br /> tat.. --t+ <br /> z 3 a <br /> ra. a 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> Q R <br /> Printed/Typed ed Name <br /> E yP Signature Month Day Year <br /> R <br /> 19. Discrepancy indication Space <br /> Z F <br /> - a <br /> 1 <br /> f 20. facililyOwner or Opera w Certification of receipt of hazardous malerials covered by this manifest ecce i as noted in Item 19- <br /> 2 Prinled/Typed Nome Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> [DTSC <br /> 8022A 11/991 White TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> PA 8700}-22 To. P 0- box 3000, Sacramento, CA 95812 <br />