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J1Pte Pr+rOn+oe nia—'t_iiv it Primerna+r,4eEGnan ntjcri�r L <br /> Farr»Q++Droved OMB Na.2050-0039(Expires 9-30-991 See Instructions on back of <br /> Page 6. Department of Toxic Substanc?s Control <br /> Ptaase print or type. Form designed for use on elite(12-pitch rifer. T Sacramento,Cebfornia <br /> nerator's US EPA ID No. Manifest Document h 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS I Jt is not required by Federal law. <br /> WASTE MANIFESTof ` <br /> 3- Gene fa am and sin A dress A State Manifest Document Number <br /> C <br /> _ - - -_ .L 4 0 4 4 4 , <br /> 4 ` Ae L t _ Cv� ,J y B Stab:Generators ID. <br /> Ln d. Gcnerafe+r's Phone - <br /> t\ <br /> cV 5. Transporter 1 Company Name b. US EPA ID Number C.,Slate Transporters ID[Reserved.[ -r;A Lf t 9'.x136 <br /> to L , <br /> Er! -� i S ') `] -� ,� P '�T'asporter's Phone e <br /> C) r;x A �Y_t-�Y re mol J.A9`.. .V�.. r.� '..J ✓ a ' <br /> 7_ Transporter 2 Company Name B. US EPA ID Number -E' Slate Yansporfers!D-Reserved-] - <br /> [anars'Phone <br /> ^� U 9. Designated Facility Name and Site Address 10. US EPA ID Number Fold rlflj?#}''s'ID <br /> �s <br /> rzi Z .�2.6 N. Mar!sa Av } y J. <br /> Ilya'sFfrane <br /> rJ 0 ;=.rL S;-.�,`, {...L` r_ J I. 7 J iJ !? ! f.? 4k'ttR <br /> Q12_ Containers 13. Total 14. Unit 'I <br /> r-A V I 1. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) Na Type Quantity Wt/Vol I Waste Number <br /> •V Z a- I{t,.f'sfs.;"4oz:vL1ti!1y l/liwi* i-'.-J'CC? i ixf';_J L.'fl:'ii <br /> r. EPA/011ier <br /> G - 't --F I 1 4.5 t _- i L';06� <br /> O N( b Stale <br /> ace E <br /> -V R EPAIOther <br /> c_ State.; <br /> T R EPR/Other <br /> LU d. State <br /> Z <br /> V Other, <br /> LU w <br /> Adr�trortpfT)r sertp}tasYfar'FAatera I`s 'sted.Abwe andlrng Codes for Wastes Lrsied Abe e <br /> d * w3 ssr csNi }L2?4 to S f b <br /> a"rR r a+--'3 `�r„�e ?ten. ,x mom•,s+i,� - <br /> ' yr- _.,1 ,�„ ',r f ,- f`r` '.-r'x '•fT}r'�7'''t; ...,.F' "'' .ta d <br /> r •j� <br /> Z 15. Special Handling Instructions and Addifiona'I Information z. "' EME G3 Fit- <br /> Z is +�`Ytia J,tsi e'y %tt,�lltic:% ijfi�`'a.•4 e <br /> LU <br /> Z <br /> t- <br /> J 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name andare classified,packed, <br /> Q marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> C.J , <br /> If I am a large quontity generator,I certify that I hove a proggram in plpce Ip reduce the volume and toxicity of waste generated to she degree I have determined to be economically <br /> cry <br /> practicable and that I hove selected the racticable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> and the environment;OR,if I am a sma I 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 /> O <br /> P inte- /j ed Na - Xtorex., nth Da Year <br /> ; ' <br /> 0 T 17. Trans ef_ Acknowledgemeni of Receipt of Materials <br /> c]CR <br /> A -Print re Sig Manor Dam Year <br /> / <br /> 5 <br /> LU <br /> p le Trans orter 2 o of Receipt of Motorial, <br /> R <br /> T Printed/Typed Name Signature Month Day Year <br /> "a E <br /> N R <br /> („) 19. Discrepancy Indication Space <br /> Z F <br /> — A <br /> C <br /> I <br /> L <br /> 20. facili Owner or Operator Certification of receipt of hazardous materials covered b this manifest except as noted in Item 19. <br /> T Printed/Typed Nome Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DISC 8022A(1/991 Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />