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- ----- -- - --- - - -------- <br /> Stora o1 Cal-mio—Erwironmemd protection AgencyY ' -. S0@ IIIfErUC110f1f OFI back of page 6. Department of Toxic Substances Cmd.1 <br /> Form Approved OMB No.2050-0039(Expires 9-30.94) Socram uo..California <br /> Plea u print or type. Form designed for use on alba(12pkh)typewriter. <br /> 1. Gmr <br /> eator's US EPA ID No. Manifest Document No. 2. Page 1 Information the shaded areas <br /> I UNIFORM HAZARDOUS � � is not required by Federal law. <br /> f WASTE MANIFEST °f <br /> ` <br /> 3. Generator's Name and Mailing Addres /y^y t,'�Lys,, <br /> t / ' esf QoTu rsF u e= � <br /> an <br /> , �/ ��Y� N }ole Gemeator's ID <br /> n I <br /> OOOh 4. Generator's Phone;t�)4(/pr 7'0C <br /> 5. Transporter I Company Name 6. US EPA ID Number C.Sm1e 7mnspoAer's ID A')�1 <br /> Tgor.porter's Phone <br /> 7. Transporter 2 Company Nome 8. US EPA ID Number Mate 7ranspoAals ID <br /> UF.. Tnnapodeis.Phony <br /> Q 9. D�dpnyledd FoPy Name and Sib Address 10. US EPA ID Number State Fa<rh 's ID <br /> Z N/C- r M..' N S�� <br /> I S 3331 ,V I <br /> 12. Containers 13. Total 14 UM <br /> Z 11, U5 DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) No T Ouanl" Wt/Vol 1 Wago Numher.'.. <br /> (nm a. S /0 St <br /> N 3 <br /> Ifcq 5tae <br /> o <br /> H b. <br /> edp E gPA/Athgx <br /> R �Mt IN <br /> A State. <br /> T <. <br /> O EPA/Offer <br /> R NOV 0 8 1993 1 1 1 <br /> State <br /> Z d. ' <br /> U ENVIRONMENTAL HEALTH I EPA/cher <br /> N <br /> VICES <br /> IQ WPstas listed Alcove <br /> Wa' 7Hond�,�7 <br /> S d �T <br /> Q i 'ts <br /> 0 115. Specialcgpn,s and Addi nol Information / S(vU 7 C,'ct fl E". .✓ G f_'E.rv'f7T 4.r <br /> I.0 <br /> h <br /> J 16. GENERATOR'S CERiOFIGTION: I hereby declare that the proper <br /> condition <br /> of the consignment are fully and accurately described above ,s proper shipping name and are classified, <br /> Q pocked,marked,and labeled,and are in all respects in proper cond'uion for transport by highway according to applicable federal,state and international laws. <br /> U <br /> 1 If 1 am a large quantity generator, I certify that I haw a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically pradi<abro and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> Nthreat to human heahh and the environments OR, if I am a small quantity generator, I have made a good faith effort to minimise my waste generation and selM the best <br /> waste management method that is available to me and that I can afford. <br /> O Pry d/Typed Name - Signature Monl ,D Yao7^ <br /> ZT 17. Trans aster 1 Acknowledgement of Recsi 1 of Materials <br /> w Prinrod/T aqf• - Signoxv. . Month y <br /> W1( If -�P H v✓1 v .c� ---- <br /> P <br /> 0 18. Tram rtes 2 Acknowledgement of Recei 1 0l Malerlals Month Day Year <br /> W <br /> is Primed/Typed Name Signature <br /> O e <br /> • <br /> N 19, Discrepancy Indication Space r <br /> Q F <br /> V A f <br /> Z C <br /> I nO. <br /> kacili Owner or O rmor Certification of recai t of hoxardom mmoils coveredb this manifest exce 1 as noted in Item 191Month Day Year <br /> Td.Typed Name Signature <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (7/92) Yellowy GENERATOR RETAINS <br /> EPA 8700-22 <br />