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Sto:.of C.0 ...--Environmental Prot tion Agency <br /> Farm Approved 0N8 No.2050.0039(Expires 9-30-96) See-Instructions on back loge 6. Dzpwtm.nt of Toxic Substances Camel <br /> Meow pant or type. Form designed!w use an este(11piM`/ewviMr. S«rananto,Catifomia <br /> UNIFORM HAZARDOUS 1. C"neratoss US EPA ID No. Manifest Dmumem No. 1. Page 1 nfo matian in he holed prem <br /> WASTE MANIFEST h a required by Federal avert <br /> t £? Cl? CJ9 OS C , (! /of <br /> 3. Gemerassr's Nome and Mailing Address I �. Q�, A:Srota 7lmtw�bar - ., _ <br /> �e 95592 <br /> 1� <br /> w % )r •'Oaf 9� n j i , '' �'•; rors R. stare GerwraID _ t <br /> r a <br /> .. Generators Phar ( . ll. ,. /) t/' ,4 3 .w <br /> FT 0>' <br /> S. Tronsporier 1 Company Name 6. US EPA ID Number // (. C- Stare Transporters ID, <br /> 'r I k tfa� C 0 O W C 7 Transporters IMo te r/DV 93 <br /> D3 5- I'S <br /> 7. Transporter 1 Compo y Name 8. US EPA ID Number E. Store Transporter's 10 A <br /> V - <br /> Q - F. T....permr s N.-- <br /> 2 <br /> .- `try <br /> V — 9. Dlsgd Facility Name armd StN Address 10. US EPA ID Number G. Sante Facility's ID <br /> Z kYlm_K90Tl <br /> Wim <br /> l 7u " <br /> V0 255 Parr 61-d. _ Di< O9 �/ rG ? 9 <br /> Ri�#unxu3,CA. 94t3t11 f- ntr'• <br /> 73 5101235-1393 f, <br /> n U 12. Contain.. 13. Total 14. Unit jsq <br /> 11. US OOT perception('mcldvClans <br /> up Proper Shipping Noma,Haxard ,and to Number) <br /> No. T Ouantty Wt/Vol 1. Waste Number <br /> 1) a' "i—IKRA. HcazardrA.ts Waste Solid Stal°512 y: <br /> 3 - <br /> C; G Waste STVty Storage Tank. r ; } :'r i�:j 0 / Ti p GOO p EPA <br /> E <br /> W N b. State t <br /> 9-g <br /> a E <br /> v R -EPA/Other,:} <br /> A <br /> to T C. State <br /> 1 O _ <br /> 0., R EPA/Other y, <br /> W <br /> F — <br /> Z d. Stare'. <br /> U <br /> EPA/Other <br /> H <br /> Z J:r' '"fa( K Hendrug Codes for Wastes Lined Above <br /> O <br /> 0- y b. <br /> u1 <br /> ' c. d. <br /> O 15. Special Handling Instructions and Additioeol Informallan <br /> P: Kc—.p acav fr-ct srALr�-e_ of igniti;.ti. Pdways :.year t><-u-tkiats 4ien rrkina �c .:l.u::7 <br /> z 1!,G. ,T. 's 21 Hr . Contact N3rtw. �-='' _--_– Phcna_-1__�•.__? --- <br /> W <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the content of this consignment arc fully and accurately described above by proper shipping name and arc classified. <br /> < packed,marked,and labeled,and are in all respect in proper condition for transport by highway according to applicable international and national govemment reguloticm. <br /> U <br /> If I an a 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 determined to be <br /> aec kolly practicable and that I have selected the proctcable method of treatment,storage,or disposal currently available to me,which minimizes the present and future <br /> N threat fes human heahh and the environment;OR, 9 1 am a small quantity generator, I have made a good lath effort to minimize my waste generation and select the best <br /> of wase,momsponsed,method that is available to me and that I can afford. <br /> 0 Prk W/T7Wd Nano SigeaNro Month Day Yam <br /> U <br /> t < : / t <br /> Z 1 17. Transporter l At w6donners of Receipt of Materials �'J <br /> (� PrirNed/Typed Nome / ,. <br /> / mh DayYear <br /> Mos <br /> I, All <br /> W 0 18. Tromporl Acknowledgement of Receipt of Materials <br /> LL T Prkmted/TYWd Nome Signature Manth Day Year <br /> O E <br /> L <br /> 0 19. Ditompaecy kdicati. Space <br /> V F <br /> A <br /> Z C <br /> 1 <br /> L <br /> 1 10. Facility Owner or rarer,Certification of receipt of hazardous materials covered lo,this manifest except as noted in hem 19. <br /> T Primed/Typed Name Signature Mardis Day Yew <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8g11A (1/95) Yellow: GENERATOR RETAINS <br /> EPA 8104-71 <br />