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-T:ate of^olifomla-Emlronmemal Protection Agency <br /> Form Approved OMS'No.2050-0039(Expire 9-0096) S@@ IDf('FUf1}I@Flf OA bOCI(OF. @ b. Department of Toxk Substances Control <br /> Please,print or type.• Farm derlgmd For use,en elite(12-pikh4allm. Socromento,California <br /> UNIFORM HAZARDOUS '- neratoes US EPA ID No. Manifest Document_ 2. Page 1 - Information in the shaded areas <br /> WASTE MANIFEST 1 0 —Q ,0 i .} n r of <br /> ' is not required by Federal law. <br /> 3. Generator's Nacos and Melling Address » tate Manifest Document Number <br /> tpoo ( A.0 Coe .?. , � . y�.P ' qp [ 7/ - 9606ti873 <br /> 1.. h 1 ` n r`.`l.A• AvA. A . 1 ~f /Y:V.:s f'C? ` <br /> n (� (�s L_:r"1k w"1,.�5 /� / ',,.,i � B. State Generator's ID <br /> rA 4. Gerrorator's Phone (?)"1)57 00 <br /> Tit : , AVC C,3 C E <br /> S. Transporter 1 Company Name '6. US EPA ID Number C. State Transportai s ID <br /> DAMS C:L 12,P C:!'- IJ C. FT G.J t D.;.Transporier iPhone <br /> J <br /> -s 7. Transporter 2 Company Name B. US EPA ID Number E. State Transponer's ID <br /> F. Transporter's Phone <br /> COQ Dedp �t�d Fadl' Nei�^^^^and$ih Address <br /> 10, US EPA ID Number G. State Facility's ID <br /> �� l�Q}C u1E Wl?/i�,C� 00i%J <br /> Q (!1 V'.� PJ f•1 {..Pi(4( R. e3ftr.. H..,Fonliy's Ph0. <br /> c� C 3 t TOIL eA • ,7.2 Z- 1(4IT3 rl rCt <br /> 11. US DOT Description(Including Proper Shipping Name,Hazard Class.and ID Number) 12. Containen 13. Tocol 14. Unit <br /> Z �p No. T QuantityWt/Vol I. Wane Nu ber <br /> ern3 a. C�FC f,N4 � N,©A.l � 'p�. C• . 4 State , , { eJ <br /> .}- EPA/Other <br /> E Llov <br /> 00 N b. _ State L; <br /> pppp����pypypypy E <br /> C4 R - _ EPA/Other <br /> A <br /> T r, State <br /> O <br /> R - EPA/Other <br /> W <br /> Z d• <br /> State ' <br /> ...0 EPA/Other <br /> � W <br /> N <br /> Z J. Additional Descriptions for Materials Listed Abo K. Handling Codes for Wastes Listed Above' <br /> b. <br /> w <br /> � of <br /> J <br /> Z <br /> O 15. Special Handling Instructions and Additional Information s F t s y� C 4 c( 9L <br /> 1 t <br /> Z <br /> Tri Yo uJA7Ee 7tibj ?Arifr( �il.7�LUFL.(Ll n <br /> !1/ pearAel3o&) SrticRTv.a• *� 4, G,as;: yC nJ5 <br /> -s 16. GENERATOR'S CERTINCATIONs I hereby declare that the contents of this consignment aro fully and accurately described above by proper shipping name and are classified, <br /> J <br /> U peeked,marked,and labeled,and aro in all respect;in proper condition for transport by highway according to applicable International and national government regulations. <br /> J If I am a large quantity generator, I eertily that I haw a program In place to reduce the volume and toziefy of waste generated to the degree I haw determined to be <br /> -y <br /> economically practicable and that I haw selected the practicable method of treahnent,storage,or disposal currently awiloble to me which minimizes the present and future <br /> N threat to human health and the emAronmentr OR,R I am a small quantity generator, I have made a-geed faith effort to minimizemy waste generation and select the best <br /> gC waste management m mod that Is awtable to me and that I can afford. - <br /> O Pdiited/Typed Name A Signature+ Month Day Year <br /> Z T 17' Transporter 1 Acknowledgement of Receipt of Materials 01 e <br /> L Pri ted/Typed Name Signature Month Day pYearr <br /> (�. 0A !7 r F' C.l0 AJ �„v„. ++•.,, d �e O / L� <br /> u�$ 0 1S. Tnamoorier 2 Acknewled ement of Recei t of Methanol. ' <br /> sty T Prier /Typed Name Signature+ - Month Day Year <br /> O 1 r <br /> r <br /> V) 19. Discrepancy Indication Space <br /> U P <br /> A <br /> Z C - - <br /> L <br /> 120. Facility Owner or b <br /> rotor rffkaNan of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Pdnted/Typed Nome Signature Month- , Day .Year. <br /> r -)"- Ci (7 f <br /> DO NOT ,WRITE BELOW THIS LINE. <br /> j t � <br /> DISC 8022A (1/95) - ^ Green: TRANSPORTER RETAINS <br /> EPA 8700-22 <br />