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<br /> j SIM,a1 California-ffeatlh and Weller,Agencv Tmir::uMlnnrm CnnU.,l Pivi. .„
<br /> to,..ApPrMld M'D No.4050-W199(E-01-8 9 00"A) nuncrnmpnlo_,_CRId•_,•
<br /> 1.1(.•.InInt M IYpe. fForm don!gnad for OR@ on Wife(I2 pitch ryy 'f 1 MPnun.l 7. PPn9 I I t arena:
<br /> 1 OPna,alm'e US ErA ID NO
<br /> Inlonnalbm In 1111, .Imdr•r
<br /> UNIFORM HAZARDOUS flnrumm,1 Nn nl is nal 141.1-111"'1 by Fcdm nl hrw
<br /> WASTE MANIFEST n4olF I J / n SIn1a MRnilnn.Dornm.nl Nnmber
<br /> J n..tm)An.and Moiling Add,... ' ' 1
<br /> I _ B. Sleie(iP.O1R1nI.IU
<br /> ��I I14/p C/J el'1 /'I 'T ..1
<br /> 4. Oenmeloi s.ions(K], •/) �,it n- /.,
<br /> G SIPIe Irnneanrini s
<br /> A ID
<br /> S lranaparlar )CempenY NPma US EPA ID Number -
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<br /> EPA ID N.mble E. SIRIe ir,nnym mr'e I r ) /�_ .
<br /> 1. Transporter 4 Company Name
<br /> = L.) • .— F. lranepwlnYs.hon
<br /> P./D�aalpMlad Facllily Name and Silo Address �
<br /> 10. US ErA In Number O. Stale Paraiw-ID
<br /> /c;::L rLrnIGi phone1Y�Lp111 � L
<br /> ell 'N I -1 ,'JCJ
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<br /> Ouer.hly Unn Wnnl.till
<br /> 11. till hot Macdpllon(In.Iltna g Proper Shipping Nam.,11.1111d CIaa R,and ID Numh„) No. Iva. WIN" -..
<br /> Stata
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<br /> N JJL/c_�_�(,�y I 12 T —1 11 A
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<br /> R Ernnrner
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<br /> ErAlan,er
<br /> _L _L- I I- _. .. - --- -
<br /> K. nAndbna Cudna larIWaeue Lowd Above
<br /> J. Additional Descriptions for Motorists
<br /> bllele Llalad Above i , ! e.
<br /> C. d.
<br /> 16. Special Handling Inatrurnons and AddlOon,l lydo,m.11nn
<br /> i
<br /> 16. d nbovr by 1' 1 `' l l
<br /> OFNERATOR'S CERTIFICATION: I hereby domfole Ih-I the ronlnnta of Ibis cnnsignm.nl are hilly and nruual nlY dnsrnib., v.n•i hi �nm
<br /> Mme and are classified, parted, msf%ed, and labeled, and are In all reapecls in pnrper, ronddlon 101 h3MPafl nv nfghway an;.dma In :"'n" :d,l"
<br /> International and nnlionnl gnvarnment r.gulatlons. .nlyd 1" On• d......1, I h.—
<br /> if l am a large m.anlilY genP,Rlo1.I cr•rlily that I have R prawn.in Plarn to mdurn the'minnne mal Invicily sh,M'11 slnnl,din n•.ntl4 ......
<br /> :d,l,. . •
<br /> determined to be ern.orninMIY pr Rclicn M. And Ihnl I have anleelnd Ihn IIIPCIIGIt1IC "".lista nl brnhnrnl, 1". I`^''" '
<br /> no, which mini.i,.1 the pros,.] and Nor, lineal to human hnallh And Ibe pnvironmrnl', OR. it 1 am n "mall """"ly panni ata., I h:rv.• "orb• n """'1
<br /> faith effort to minimize my waste generation and select the best waste ma"agemP.t m.lhod that is available to ma and 11,811 uu. .11o'd
<br /> _ - Manlh...MY Vee
<br /> Prinled/Typed Nome I Signalure� /. •� ,
<br /> IL TrRnspnrter I Aellnoelodifthrent of Receipt of M.Iwlale
<br /> A ,hed/T P. Nam, Slgnalma
<br /> P 16. transpMer o
<br /> 2 Acknwledge Rel of RRc Rlpt of MRlsolls
<br /> O Manlh f1Py--- Yum
<br /> IlSignature
<br /> t PrMIed/Ty ams
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<br /> I9. Discrepf envy ledicat 6n pace'
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<br /> A
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<br /> 1 70. recall,Owner or Operator Cer111lulion al receipt of ho,mdous malmiala covered by Ih.e manila Rl except no nolnd in If..
<br /> Mnnrh OnY 1'na
<br /> T Prinladl Typed Name Signntur,
<br /> _V
<br /> jr,A024 A(1167) YELLOW: GENERATOR RETAINS INSTRUCTIONS ON THE BACK
<br /> 'A O400-22
<br /> ..v 9 At8 PmArma wd111Ma al.'b"'W".
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