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�nemio—Enmronmemal Protection Agency <br /> crowd OMB No.2050-0039(.Fres 93094) See Instructions On back of page 6. DePanmmt of To..Substances Can,,.[ <br /> prim or ype. Form designed for use ce dine(12puch)ypewritor. socrameem.Calisornio <br /> t UNIFORM HAZARDOUS I. Gegeratm s US EPA ID No. Manifest Document No. 1 pa, I Information in the shaded areas <br /> is not required by Federal low. <br /> WASTE MANIFEST r' ? I a1 <br /> 3 Generators Nome and Moiling Address I A. State Manifest Document Number r c <br /> I ? ?� I f r 2 66 4 <br /> A,' r,'I K <br /> r\ ' '�' . AR✓�:1 •���-yn�� J Generator's m <br /> ssn Generator's Phone O 1 r - <br /> 8 5. Transporter 1 Company Nome 6 US EPA ID Number C State Tmmpo ree''ID <br /> 1 n r ' D.iransporte(s Pham. c <br /> �,aLCG�t; ,.irt:I\GY �,, � rti� !P< 1 2 <br /> Q7. Transporter 7 Company Name 8. US EPA ID Number E State Transporters ID <br /> h/ <br /> rQ F. T'amporfer's Pham <br /> 9. Designated Facility Nome and Site Address 10. US EPA ID Number Gz. State Facility's ID <br /> Jox F - <br /> rISOfri 'IVIROf.'irlrliiL � <br /> rv1. <br /> OF r . .�., .r C ; H, facilily'aPhone <br /> a 7 'y <br /> 11!US DOT Description(including Proper ShippingName,Hazard Class,and ID Number) 1Y. Co unci 17T0a1 <br /> 14 <br /> Unit <br /> No. Type, Omnflry WNV<I I Wade Number <br /> ° State <br /> 3 G .'10Pi 'f-TA "Ni-1 —DOUG 'rJASTL, LYTID EPA/8; e <br /> 42. <br /> ri E <br /> a�D N b. State , <br /> N R K n„y.� EPA/Other <br /> A <br /> MAR 3 1 1393 State <br /> ad R ENV[ROI N';r 1`J1Ti-'.L HEALIH EPA/Other <br /> W I _ <br /> Z d: PERIVITI, ttVIIiCJ stale .. <br /> W <br /> U <br /> EPA/CMher <br /> u <br /> '! Additional Descriptions for Mciarwk listed Above -`; K, lbndlmg Codes for Wastes Listed Above <br /> of DIESL FUEL. SPILL Af3D WATER: b. <br /> C <br /> J <br /> Z <br /> 0 15. Special Handling Inso-uaions and Addbional Information <br /> s= <br /> Z rn)JR Plij'iE NUiJURkn C17) TL-1 rMERGE'vCY 'JII'r. <br /> W <br /> x <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> Qpacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,slate and international laws. <br /> U <br /> If ! ant a large qu.ntit, geraratoq I coaify tbaf 1 have in place to reduce the volume and wtticiy, of waste generated to the degree I have determined to be <br /> 2 economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> N threat to human health and the environment;OR, if I am a small quantity generator, I have mode a good faith effort to minimize my waste generotion and select the best <br /> a, waste management method that is available to me and that I can afford. <br /> 0 Primed/Typed Nome Signature Month Day Year <br /> Z r 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> W R <br /> Vr • Printed/Typed Name Signature Month -Day Year <br /> W $ <br /> R <br /> o 18. Transporter Z Acknowledgement of Receipt of Materials <br /> W R <br /> sz- <br /> s Printed/Typed Name Signature Month Day Year <br /> 0 E <br /> 0 R <br /> w 19. Discrepancy Indication Space <br /> N <br /> Q F <br /> U A <br /> Z C <br /> 20. Facili Clwner or Operator Certification of receipt of hozardous materials covered by this manifest except as noted in Item 19. <br /> Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br />