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Stme of Califomio—Emnonmerfd Prosection Agency <br /> Form Approved OMB Ne.2050.0039(Expires 9J 9,1) 1%W See Instructions on back a�a e 6. <br /> Please Pdm o type. Form designed for use an efisr(l2pihh)Typewriter. �`�' 9 Deportment of Toxic S California Crmaol <br /> Swromemo,California <br /> UNIFORM HAZARDOUS 1. Gaherm°r's US EPA ID No. Manifest Document No. 2. Page 1 Infamsarion in the shaded areas <br /> WASTE MANIFEST 6 A p of Is not required by Federal law. <br /> 3. . r,_gdCs/i dd ss /tEf 5TrQ7' 09S'e? A:`:Stab hignikst'6oamlosk Nons6«` ::n. <br /> .340%A!1 t/"TOO 9` 583 �3IO7,�-1�5pTe,,VYY-&V4) <br /> NI y, eel. q::5,30cF/ Stat atol's ID •5. <br /> .. Generator's Phone 3 /I <br /> Ls�ol 8ya?- bSSZ ,, + <br /> 8 5. Transporter 1 Company Name 6. US EPA ID Number <br /> :iSMeTroyporter's ID <br /> �h*- <br /> ` ��l,wJl Q yNL r D 'ampor)er's <br /> Q7. Transporter 2 Conpony Name 8. US EPA ID Number E. Sfafa Trwuporte s ID z_ <br /> V :a <br /> F 'Transporter's Phone <br /> Q 9. si9rrvte;f foci" Na and <br /> SAe est 10. US EPA 10 Number G" F <br /> ohiEmi r _ s <br /> A° oi26)8/ BAv "POA6 <br /> ILIa .EAST�A cV A(70 �r4. 9 303 (oLS <br /> U - 12. Comain<rs . <br /> 11. US DOT Oeuription(includirhg Proper Shipping Name,Hazard Class,and ID Number) 13. Total ll Unit <br /> No. T Ovantity wt/Vol <br /> WASTE FLAM MKB iC�UL seas s ` <br /> '73 (GASOILT,E) 3 , Lkvk\q93 0014" <br /> o E <br /> pe N Is. <br /> og E <br /> N R <br /> e A <br /> 3 T <br /> CP O <br /> w <br /> Z d. <br /> W <br /> U <br /> w <br /> N <br /> O <br /> o_ <br /> At <br /> Z �...... -^.F.. :.-. <br /> 0 13. Special Handling khsvuetans Card Additional Information <br /> a ca�i�f�LtrfR.�✓yl,��.EHrfv.. <br /> Z <br /> t_ <br /> Che11,-o4.Em,67,enr - kco-a3i-ole <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are cks-lied. <br /> Qpacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and nofianal government requlanam. <br /> U <br /> If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste g.r mfad to the degree I have determined to be <br /> �_ ecorwmicolly practicable and that I have selected the prrMicable method of treatment,storage, or disposal currently available ta me which minimizes the present and future <br /> a threw to human health and the m,wonerent;OR, 3 I am a small quantity n <br /> N q ty generator, I hove made a good faith effort ro minimize my wash gehseratan and select the best <br /> waste ma man method that is available ro me and that I can alfwd. <br /> 0 Pr;�ted/Typed Nome Sig 17, <br /> r •f LZ F8l ��.t,' <,i°4 ' i J � .• e c r_-,. c K - -- <br /> U <br /> Z 7. Tram ro m <br /> er I Ackere of Receipt of Materials <br /> e <br /> W A P.i d/Typed Nome <br /> 0 w r 9 nt <br /> a' s rC <br /> w P <br /> 0 18. Tre .ter 2 Acknow emZZ <br /> ent of Receipt of Moteriah <br /> w ti Printed/Typed Nasse Srwnsre Year <br /> I I <br /> 9 Month Day <br /> 0 e <br /> w 19. Discrepancy Indication Spwe <br /> N <br /> UF <br /> A � <br /> Z C <br /> k <br /> 20. Foil' Owner or twat Certification of recei t of hazardous materiels covered b this anilest a etas hwted in Item 19. <br /> VPrinted/Typed Name Signature Month Dcry Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC II (9/93) <br /> EPA 8700-22 Yellow. GENERA TCR .RETAINS <br /> R <br />