|
07/20/2004 10:02 916-38 16 SACTO 0-C 760 PAGE 02
<br />' fwmlia-Emrimmmmid?P cllma Agen4y -^'-•�ci:� •vA 1'nafrueHone'on badeb. .,'•, .
<br />9 TT,, +,r'•" • �,. rtmIIII OFTOfu Sllh`il m Lamm
<br />ved OMB Ne. 8010-0039 tr=Pim' 30991 .. , >'�L''i; : ,.r ri•, ape .
<br />Fvrvm en e0N (18-POdrl "9-6r r. •. • •• , r +. , p.rry-•,• •"r a r.'r-T`++',t+':: , aaa CahMmla
<br />,w ryP•. Ferm deelgmd ... • 1 IrsMrmaeien I Iiw dwded areas
<br />1. Genwvbr's US EPANNo- .,ls�ManiMlpammamMo, rib• � lemd n9pir•d 1'1'F.d.mllvW.
<br />.. UNIFORM 1#l47ARDOUS ("RL_J0"; A Q<i'C '!•= _r: �r"i.'i��+'.^::�}'21 CI! a,ns n m , •r, t.. �S
<br />WASTE MANIFESTdF:
<br />wewr'f Name and Melling Addross .".7'111<-4L ''t•1h.LGT
<br />iv ;71
<br />A. Gemrotori Nano 1 ,:`;''+1
<br />d. US EFA N Nondmr ... ,.,T,1 �;'•;ry, vv"
<br />N S. Transparler I Company MGM, .: � :• •, �� . { , " vfJ:¢` , MI,°M: '.
<br />va. US 13A ID Numbw
<br />17f 1pgnrll
<br />7, Tmnsporler 2 Cpmpany N. ,pn, w
<br />7 U 9, Fhsipnmed Faellly Now and Slte Addr6u C. • 10. US EPA lD Nrrmbw
<br />/
<br />wQ •.. _ -'N.:..F1'::•, ,=!__ d:q..v• ;.i i\. ♦.. ,1+♦�5.�J• �'% � r h, �' iY14
<br />CA000
<br />;0
<br />�
<br />CA r"Jo
<br />rs'2p- �/.!
<br />o,
<br />'Q m •pE .: "' 1Z Carllob.n ','13"Tdrd IA. Unit
<br />J U I I. US OOT DnaripXva Including Paper Shipping Nams, "rd Class, and Numb�i. � r �+,-' Ne. T {'9uaMl � WIIYeI ds' u -
<br />rZ ,,,,.,.P•.: y� r:� •• q-• t , lJ3•y,',.'', :i,Q.''. °Dorf E^_r , .:5
<br />x "
<br />:r"R.*, i4,_ •nF..tF I.•..FlirffLk: ^M' Ci. rY3 .>:a•.
<br />>.:.•.' .7 :7 V•' T { t F•.'1 rr"Ij T :1r'oAj. ..
<br />,.r•ct,F.r_ ...t,', 'girl
<br />_EN-
<br />SC
<br />_ ✓ 44 Mlo F4C"fj, `r:e y _ Ulhe[, ..ru
<br />N / . :. ,; .rr,:, . _ •+'app':
<br />... :.. it
<br />T ...•S (:: rq .y,Fw •":n•.'iO1il{ty }a. •'f 1
<br />_ 1 ! v� 3
<br />op
<br />R
<br />A
<br />o T -
<br />a7 O
<br />q.
<br />W
<br />y
<br />Abaq"
<br />pt
<br />Z J Adddianal Dgaal Ian.,Ivr Aklwid �a Jlbew9"i ,.r
<br />• n
<br />� t.•
<br />' �, �iiyyiwl l•iTi •� F1i t't{�+ _ .. ::
<br />1 S. S • (i last�mnp and Addilinml InMmaRan V's t.J a V `FvyS', ,1 ✓ m' f � •�'`, .
<br />^ r, peelel Najd. .^.S
<br />�C'E,_..._,.....-•,.F':.?t,'-'-'a..,..r,..-,..,:+•,.nr'...,.:�4.
<br />az
<br />`fie .::,va. r i :;�Ir;fo•:i'J-"I'ca�-''lnfJ �4i+Ci ;-'� �A?'".^-p.�. .. N. "'�^?I:.!=L� ..l.i, .:7-Y.Tf'.ti�i I:'x?+id3ECiIIf,_CARRI. ,.� .p.��t��5'l">. ,
<br />• „i ••%'7•,,M,..L F.• tom' yy •Y... ,'T
<br />. 'yMrMoa,, V
<br />r a ked,
<br />r 16. ;*XRA7WS CUMFICATION: Thereby daelmedmr Xr. mnl.nH eFfldseeml� len (ud)'MCI eewlvYly daurlbd PvparshlPPlnp nano and an tlmARed,p
<br />U marked, and I-how, and am in all mepecn in proper mndllim for hr mas hY hvrmy'u nr g b OpplIc" in and rwhanN 991 "PICH! s
<br />f >w
<br />rIf i am a large quonXry pen:.mwr, I ceXly that I have a In plan fv nduwdn 'AM* end roalely OF.,ede gemmrod9e lire daryw I baro dxermined b ba eeanamic
<br />h prneSeaNe aId lhvl I Trow seleaed eh. pmelicable methom0 A kImp, W dispmal mm* mailable ro me Which m i . du pruam and fNun th.eal ro hamon h
<br />and Ihn environmvM; OR, If I um a mail quanXy gon ow, I hero made a peed Milt aaarr b minhnisa my Wada gemraF and edeas Xn h.M'aasle'n°"°g°maM m.Xad That is
<br />W available b me and Mal I cvn afford. "91
<br />*
<br />Prinled/Typad Now
<br />T 17, Tmm nor 1 Akkn 191 R-bi of Mwwbls w y,�p, pay Ye r
<br />E Frinmd/Typed Name '.. `/f, sibmanve / -"�
<br />7.
<br />W 0 111: Tom rM 2 Aakn l amem'of Reml t of Mvledals r Mmlh Day Year
<br />O R Pdnled/Typed Now Signmum .
<br />q i
<br />�} 19. Mmrapndey lndicvlinn Spar .
<br />- A
<br />C...,. ..-�Y:
<br />E 20, Facfli C W r w O w c.rtiacalien ei rami of hazardous ma a als amvnrd Mis manlhsN m nald In Eenl l9
<br />T Prinmd/Typed Noun. Syn9wn .1r. r:W,': ,-s,•�.,. \ Memlf Dayir Yavr
<br />`
<br />DON
<br />NOT WRITE'BELOWIH!S UNE.:
<br />a
<br />g;.;.^.,�i;;y 'Whi1u: ::TSDF'RETAINS
<br />DTSC 8022A f7 J991 :. iS$tq. - .. -':. y...� Q*ss.S�-�'eJ,,..
<br />EPA 8700-22
<br />' . .•.'':'A'F,'_b;;':.. ,'.':....,
<br />
|