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F,eb 08 02 01 : 50p Preferred Customer 20 68-3880 p. 3 <br /> r "ae of CaGfornio-•Ervironmen•al Pro•atlor A4,cncy <br /> 1 <br /> Porro Apprai CMB No.2050-00391Exp'res 9`30.991 I See Instructions on back of page 6. Department of Toxic Subflcnces Con <br /> Please print or type. Fom desigred for cso a.+v0o'I Z•uitc4;typewriter. Sacramento,Calilorria <br /> . Generatoes US EPA iD No. Mondest Docurrant No. 2. Pcgei Inlo7atlon In the shaded areas <br /> UNIFORM HAZARDOUS is not required by Fcde,al law. <br /> WASTE MANIFEST , �v '.`L " all <br /> � <br /> �I.1 . , y <br /> 3. :,enaroq''s Nore and,i leg Ad.riil L4 l r,I C1 A, Stale Manilest Docurrnenl Nvmber21154762/ 1 5 4 7 6 2 <br /> 1. I "jet <br /> o GY �(1C.Y '�GY B. SIo*Genmators ID <br /> v) d. Coenerato,'s Phone <br /> N S. Tramporter 1 Company Nome 6. US EPAiD Number C. Sbh7ransportehlD!R se .i <br /> V) <br /> W 12 7 a D. fronsporter's Phone <br /> $ tiA..4O �A'-crf�- 7 S00.732 � <br /> a0 7 Transporter 2 Company Name B. US EPA ID Number E. Slot.Transporler's ID jR.s .I <br /> N J F. TranspoAer's Phone <br /> U I oled Facility No a qnd Silo Addreft 10. US EPA ID Number G. Sroh Faalttyb i0 <br /> IV��YUANK tot►�TftP,v;�►'E >,; . c ?►11L 10 10 X01" P P P i� ►t <br /> eta Z Q H. Feeility's Phone <br /> CtL CLAUS ROAD <br /> 1/�� f <br /> Y/Q r•♦ 1 i n i, ! c'.1:.. - 4 LP. <br /> i1V�F*f�nyll.Vf•1 rjJ sV r <br /> � 12. Con!ainers 13. Tort; 10. Ud�t <br /> 11. US DO-Deserlpnon lineludir0 Proper Shi Pp ng Nano,I-oaard Clti and ID Number) No. Type Quantity I Wt/Vo. I. Waste Number <br /> = seal. <br /> N z <br /> i <br /> NON-NORA HjVAF'0,'JLJ'i WhSTE LIQUiA <br /> all <br /> 1 T T � � EPA/Other <br /> 3i c <br /> E Stat. <br /> o <br /> E b ; EPA/Otf.er <br /> 01 E <br /> vl R <br /> A c I Slate <br /> p T EPA/Crhv <br /> a 0 <br /> R Sra to <br /> oc <br /> w a, � <br /> Z :♦ EPA/ober <br /> w <br /> v <br /> wK. Handlin es for Wa <br /> 1.1 sMs Gsled Above <br /> J. Aodlional Dncriplton)for Motr ials 0,118 A;t . ` b` <br /> Z 0, <br /> '1 g OILY 1i'EAT'F i� <br /> w c• d.. <br /> LU <br /> J <br /> Q <br /> 15. 5pedol Hardline!nstructlom and Addhlorol lnfcrmolivn <br /> Q <br /> z <br /> W EMFT�LFri:l' t>hC'i 1k:. '?thy-ra67-FiB�� <br /> '6. GENERATOR'S CFRT1FlCATION! ,hereby declo.e Ihoilro contont,of Ibis Con.. nmentore fuly and oecurohy davibed above by proper shrpp!ng name and are c ossified,pccked. <br /> Qmarked,and labeled.one oro in all raspcc-s in proper condition kr Iransporl by highwoy occording w applicoFsle In•ana+ional end notions'gov.rnmev ragvlallons. <br /> If I am o lo•Ee quality genaranr,I cern y'hal I hoe a pro^rom to plan to reduce the volume and toxicity ai waste generated to the degree I have delermloed to be eaonorl:olly <br /> a If I amable co chat hero smear,the p�o'hot ole met�od o�'reotme <br /> fear d°spesal currently ovoileble to ma which minimize*•.h.present and fvlu re threat to hvmon that <br /> era tti.environmoR;OR,h em a smoP cuanti'y gonororor,I have mode a good teeth effort to minimise my waste geaenlion and select the boil waste monogem.en•mel'.od that s <br /> available to me orc rhos 1 ccs ciford. <br /> Men•h Day Year <br /> y Prinr.d/Typed No <br /> Z ,..� <br /> T '.7. Tran oar 1 Acknowled e�nunt of Re"c'of roaloriols Year <br /> Monh Day <br /> C9 R / Signal re' -/ <br /> � 19A Pr'lyed yped Narna I,.._. f <br /> p8 rar000rl.r 2 Ac ,ow -oomonr of Racni +a Materials Month ?ay Year <br /> O T Punted/TypodNotne Slgnolure <br /> w C <br /> H R <br /> 19. Dlseraponey Indlemien Space <br /> Z F <br /> _ Q <br /> C , <br /> I <br /> L Veer <br /> f 20. teeth Ower Cp.,! <br /> sp oior Carr'�Fi_otlon cf roto ,of hozordcus materia!s covered 6 thi+ an sxce t as rete in Item Month Day <br /> Sigraluro ^ D s <br /> T Primed/Typed e U <br /> Y � <br /> DO NOf:4/RITE' ��LO1N THIS E <br /> Croon TRANSPORTER RE-ANS <br /> CTSC 5027A ll/991 ' <br /> EPA 671 <br />