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Slate of California—Enviranmental Protection Agency ��-/ T.v See Instructions on back Page b• Department of Toxic Substances Control <br /> Form Approved.OMB No.2050-0039(E,xp4fes.1-30-99) 5acramemio,Caliiarnia <br /> Please pant or type. Form designed for use ao?feta f I Y Pit< wr f- <br /> L <br /> 1. Gonerator's US EPA lD Noc.:. Manifest Document Na. 2. Pogo 1 information in.the shaded areas <br /> s' .t s not required by Federci low. <br /> UNIFORM HAZARDOUS y -j. C � ' �� , , t <br /> + [ <br /> WASTE MANI`FE5T � 0� S� () � ti; � aF <br /> 1 r A. State Manifest Document Number :•� _. <br /> f 3. Generator's Name and Mailing AddressU 1(71 ' <br /> v V fir <br /> /4 L <br /> r 5. <br /> !!T-,,G,*rorar,)r n r r' , s � <br /> 9J] u4S—r(S9)7- <br /> C,. <br /> c r� 4. Generator's Phone I 4 <br /> rL ^ 6. US EPA ID Number'. State Transporiar's ID(Reserved.) <br /> tv 5. Transporter 1 Company NameF <br /> i? <br /> E <br /> mV A L t A r}' •,3Y.; - °•> iµx '1' :Tf f 1'r D, Transparrer'sPfiane -- ' <br /> .i ,'.. <br /> ' Q f! E. State Transporters ID[Reserved.] , <br /> 'B. US EPA 0Numbor <br /> j 7. Transporter 2 Company Name ri T• Y <br /> t F. Transporier's Phone <br /> _ <br /> Q ' EPA 1D N G. St Fav�ty�l IDr� I , <br /> 10.•US umber <br /> i � ' V ¢''ii7esign4led:Fgcf,IliY N�amr and Sjtr/;`ddrgts;::ii..� a.. - �f • , €�.,: <br /> Q �� {f:f3 C 4 .x tJ ROAD � o� •+it <br /> cy <br /> �y. - y - 12. Containers 13. Total IA. Unit ` <br /> sL WY/Vol I. Waste Number <br /> u5 DOT Description{including Proper Shipping Name,Hazard Class,and IQ Numbed= Na. Type �V°nhty State <br /> • ,� <br /> 7iA7AV(0QUrr S1VA~i <br /> a. T ,_ _] a s EPA/Other <br /> w Stale <br /> 3 G " '� <br /> _ N � 6 b ti '+ s��3`>• EPA/Other <br /> O0m State <br /> 1 ' - <br /> N <br /> � A • EPA/Other <br /> m O State <br /> R <br /> I Lau ;,d.. + EPA/Other <br /> Handling Codes for Wastes Listed Above <br /> ✓7 }. Additional Descripsions n <br /> For Mateals lssYsd Above <br /> V <br /> W.if� <br /> a <br /> LU <br /> d' <br /> am <br /> +ice r z 15. Special Handling Instraons and Additional Information l �i ��-• fJJ1 �. t f { •� h ' <br /> O <br /> z I*. +=r�� � tt�Y �I":� :�sF:: €sit3raa� ,.• -- <br /> LU <br /> W <br /> Q 1 Q marked,an <br /> as <br /> a6eied and aOe in alN. b's"spectscinre that the contents of pr Qer wnd lion for trots consignment are nsport by highwayfalccording taand rately appli abler internaiionaiyand nal n'nl government regulatlonsfied,packed, <br /> sUi v k <br /> ee I have determined <br /> If I am a large quamiy generator,I certify that t have p program in place to reduce IfiNy available to me which minimizes the present and fu <br /> a volume and toxicity of waste generated to the degra be economically <br /> proctica6te and that I have selected theproeticable method of treatment,storage,or disposal currenture threat to human health <br /> and the environment;OR,if l am a small quantity generator,1 hate made a good faith effort fo minimize my waste generation and select the best waste monngement method that is <br /> a <br /> r <br /> 0 avaiiable to me and that!can afford. µ . _,, I? ===] <br /> Montlr' r'Year <br /> HC } Prin <br /> w <br /> T17. Trona arter 1 Acknowledgement of Receipt of Materials <br /> l7 R Month Day Yew <br /> w A Printed/Typed Name = - ` Signature <br /> O d 18. Transporter 2 Acknowled emetst'2F Receipt of Materials <br /> R Printed/Typed x <br /> Name Signature Month Day year <br /> s <br /> V) E l <br /> R i <br /> V10. Discrepancy Indication Specs <br /> E ' <br /> A <br /> tgi C k o .r <br /> t� f P ;I�"} ■ <br /> l 20. Fociii Owner or O ?rotor Cerci cation of recei t of hazardous materials eovered b this manifest exce t as Holed In Item 19. rcnth�ay Year <br /> If �' Signature �' y j Printed/Typed Name, ' <br /> IAl DO NOT WRITE,BELOW THIS LINE. <br /> 0750 8022A [l/991 <br /> S ' EPA 8700-224 <br /> � G� s i..i'ris,1lJ1J <br /> l � t <br /> i Q SPECIAL OTHER <br /> ULING MUST BE MADE PRIORTO 3:00 P.M.THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SU ECT <br /> ' F3 "USAL UPON ARRIVAL. ONGOING DAILY DELIVERIES MUST.9E SCHEDULED WITH THE LANDOILL THE DAY BEFORE. ; <br /> MANIFEST 0 A R 7 d 1 <br />