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03/2_7/03 _THU 14:32 FAI 949 450 1177 S.E.S.I. 0003 <br /> BkM of California—Enuironm.nbl Prol.dien Ap.ney See Instructions on back of pa Dept rlm.na of Te.ic Subsbnc.a Control <br /> Form Approved OMB No.2050-00391Expim i 30.991 Nec Sacramento,California <br /> Pleosq print or ypa, Form deHgn.d br um on elfin p2plkh) <br /> 1.Gerer.r.6 US EPA ID No. Abnpat D«um.nl No. 2. Pop. motion in 6n shaded areal <br /> j,rise required UNIFORM HAZARDOUS I eq reed by F.d.ral live. <br /> nal <br /> WASTE MANIFEST R ' of <br /> p r {+c <br /> 3. <br /> ro <br /> Ce.MM'e Noun acrd Mallirp Add.... <br /> DC Y ea cciiiii: &i¢sLLC N Y kw.y Y TII <br /> M1 <br /> c P.O.Bmc 906-77 ;�,'•'r � <br /> silo e. G.ner.br.Ph«e 1310 11674600 Los Ft90009 <br /> S EPA ID Numb.r 'cT <br /> n.V <br /> S.TromPortor 1 Company Nom. <br /> 8 7. lronspart.r 2 Company Name B. US EPA 10 Number f 1'4t"Ip r7`h< <br /> L ' <br /> U10. US EPA ID Number <br /> 9. Deslgnold Facility Name and Site Add.eu 1 s t s <br /> r <br /> d DeMa=KNItOm— ( t:h I lh4 r 4.r 2 <br /> lea 2W 14 tLh ASIII10fib Street „� 'jF I J •A <br /> a. 71 <br /> �= 12. Cmbltler. 13.Tebl Id. U.h <br /> Q ffi <br /> V 11. US DOT D.scrio•ion including Proper ShipFi^g Name,Hazard Corr,and ID Numbed No. T no WI/Vel <br /> rJ Z a. G9501131e Mt3mlre "I <br /> FE 3UN1203P.G.II G S G 'rrp <br /> dj E 6. <br /> � <br /> N <br /> R <br /> v A <br /> T <br /> g 0 <br /> R <br /> C d �4 <br /> soon I� <br /> � � "f Jnr r'I pG �'ia j l } .0 �rT{n A'�ve/(ved i9 .r hies fl• 1 i <br /> 1 h <br /> h <br /> � '��+a t f h �°'hni���r.��b?,'}ti z,m crN�}}�"5 � , t^{"tb°J�t�,S��m Y��„ t'^' ',`a'• to y � t �.`� <br /> .Q 15, Sp.cial Nordling lrWrudiscal and Addltiocol lydermotian r, <br /> ate 3Lectioecldlkin6 ARCO 6335 B=# 53986 <br /> iGasoline and Weba miTmae. Weer ePprapn >a 4855 SaffiI HidlwW 99 <br /> (9491753.5826(24 has EnwgakcY Rime) swduil <br /> (949)450-1010(Mak-EYi 79m to Stan) <br /> ides GENERATOR'S CERTIFICATION: Ihaeby d.don lhatds.wnteme of this camige .rll nr.f. onda«anmlydescribedaba,.bypnarpe,shipping nam.andm claulf'nd,packed, <br /> IIIIII mocked,and labeled,and are in all rap•cl.in proper condition for transport by hl -y according le opPlicob4 inNrnatimrol and nolland gowrnmeM r.guialions. <br /> If I oro a large q«nti generates,I urtlIy that I have o program in place b red..the.ulama and torridly,of wmu generbbd to the degrees I have controverted b be ecanomleaki <br /> radicabb and Ibvl I hwe s.4ded IM pr okcibb method of Ir.aNnanl,storage,or dbposal currently mailable to me which minimlze,she present and future threat ke human heall6lr <br /> and dr environment;OR,i/I am a.mall quantity generator,16.mad.a good bids effort b minimize my wort.son.raha^and sdw the bort wash monapement medrod Ihol 1. <br /> 0 mailobM b me and Ilial I can afland. tisimp, Dart Y.or <br /> Sipnale s <br /> r Printed/TYMd Name 0 Q <br /> U 1 17. Train orl.,I Acknowled ..W o Racm I of Matenals <br /> P Slgnotur. OMend+ 0Day� Year <br /> F Printed/Typec Nomfor— m l O <br /> � N <br /> W 5 <br /> W 0 18. Trans 0 2 Acknowlad errant of Fec.iol of Mabriols Monts pay Year <br /> is Prinnd/Typal Noma Sipnahre <br /> Q 1 <br /> V. 19. Discrepancy Indication Space <br /> Z f <br /> _ p <br /> C <br /> j20. Will Owren or rotorGnifica0on of r.ni l of hazardous materials cmor.d ruts or it a.- as no 1 n m 9. month poY Year <br /> IT P nsed/Typ.d Nam. Signator. y l-� 9 d Z <br /> Y l C, Cl <br /> DO NOT WRIT ELO <br /> White'. TSDF SENDS THIS COPY TO DISC WITHIN 30 DAYS. <br /> To. P.O. Bo. 3000, Sacramento, <br /> DISC 50222 17/99) CA <br /> EPA 8700-22 <br />