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F.- <br /> No2end G039 Agency , 0•p•nm•ni ofB Np.2050--0008 Ea tea a - W ' Sub•lanc•r Control Dwt <br /> Form desi ned laORM HAZARDOUS GbenentoYe US EPA ID No. M.mN•1 z. P.pe IASTE MANIFEST C /4 6 3 $ Iof is notrequirmation a Iby shaded arealor's Name and Mailing Address is not re aired by Federal law. <br /> A. Sate M.nfest Oo.mesl Numb��� ��� ca � X87621043 <br /> ior a ho a IS. ) �-'o/ <br /> 6. Transporter I Company Nam <br /> 6. US EPA 10 Number C. State Transporter's ID z <br /> ���LT2A�S •_AJL CA Q61 �"8 �/O13 <br /> D. TranaportN's Phon 7 <br /> 7. Transport.,2 Company Name B. US EPA ID Number E. Slate Transporter'•iD <br /> F. Trausporar's Phone <br /> a. Designated Facility Name and Site Add.... D. US EPA 10 Number G. Slat*Facility's 10 <br /> sFAGY.,S0N / I I.tC, 1 <br /> 2 s'5- PKPA �wD , <br /> M. Facility's PhoQ <br /> RIC�t <br /> on,. 19 F3 <br /> 12. Con", rare 10. Total 1A. 1, <br /> 11. US OOT Description(Including Proper Shipping Name,Hazard Class.and 10 Number) Quantity Unit Weals No. <br /> (Y}p �,7/� per q yp p No. Type WINO ^l <br /> G .. %kjA.0r ly /6- "A1 ' (/}��9MIZ1 l7lr pp "�' . A _ Slat. i (/ <br /> E N\V«ai1�17'T RVGUL (� �fF)� �J�y EPAIJOthor <br /> N <br /> Eb. <br /> R State l.. <br /> A <br /> T EPA/Olh.r <br /> O <br /> R ostate <br /> EPA IOIh*r <br /> d. <br /> St.0 i <br /> EPA/Other <br /> J. Additional Descriptions for Materials Listed Above KHandling Codes for West..Listed Above 1 <br /> Vpwry A% , � ��► TA�.1 k # G2fo� Ice) a. a b. <br /> 20��vs:a o pf�y cu C. d. <br /> 15. Special Handling Instructions and Additional Information <br /> 1 <br /> 16 <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment ora fully and accurately described above by proper shipping <br /> name and are classified, packed,marked;and labeled, and are in all respects in proper condition for transport by highway according to applicable <br /> ' Intemational and national government regulations. <br /> if 1 am• 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 <br /> determined to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to <br /> me which minimizes the present and future threat to human health and the environment: OR, if I am a small quantity generator. I have made a good <br /> faith alto"to minimize my waste generation and select the best waste management method that is available to me and that I can afford. <br /> Prinud/TYp*d Name Signatur <br /> f dnM Dav Ye. <br /> T 17. Transporter t Ackngwledgem*nt of Receipt of Materials <br /> R <br /> A Printed/Typed Name Sipnat. Month Day Yee <br /> S J ev-Q-q P->kx-rLE(Z <br /> O 16. Transporter 2 Acknowledgement of Receipt of Materials <br /> TPrinted/Typed Name Slgn un <br /> ' E Month Day Yee <br /> 1o. 0.......no,Indication Spa <br /> F . <br /> A <br /> C <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manilas(except as noted in Item 19. <br /> y Printed/Typ.d Nem* y <br /> Sin is \ Month Day Yea <br /> �� ✓ Z 1a121d 19 <br /> DMS 8022 A( /67) <br /> EPA 8700-21 White: TSOF «PID' 71CS tel`^ i!l ;p.'-r 1'7;1 1 INSTRUCTIONS ON THE BACK <br /> (Rev.9.86) Previous edition.are oCadets, , D r <br /> —_ IN CASE OF AN EMERGENCY OR SPILL, CALL THE NATIONAL RESPONSE CENTER 1 800 424 8802. WITHIN CALIFORNIA CALL 1800.8527550 <br />