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Aug-31-2004 11 :48pm From- T-603 P-001/001 F-836 <br /> 1 <br /> Store of Collfainio—Eneimnmealol Proleclion Agency <br /> Form APpmY d OMR No.7050-0039 j6pire,9.30.99) See Instructions an back of page 6. p.partmenr e{Ta,ic Svbttnncet Control <br /> Please Pri ml or type. Fam1 del grad For ueo an&tits(12-pitch)(ypawrirel, Satromenlo,colifarnl0 <br /> UNIFORM HAZARDOUS <br /> FCI <br /> eroar's US EPA ID No. Manitesl Document No. 2. Page 1 1n(orme un a ll.•thOdvd steer <br /> is net reQuirad by Fedelgl few. <br /> WASTE MANIFESTOF <br /> J. Generolar's Narne and Mailing Address lK92R <br /> r' A. Shah Mention Datei o t Nvmber <br /> cr la 23748534 <br /> o F64: ;.tzQ e:.,s1,R.ai�.Ir am <br /> Lei <br /> j. • MWIN <br /> t4 5.Transparlsr 1 Comport m <br /> as tte .j <br /> d. US CPA to Number C, to,a'Troospo (e to(Itsar d <br /> OF <br /> o D.inampo h/I Phone <br /> O <br /> to 7. rontpor er ompony oma 1 um E. Style Ttansportai a to II LL Reavnd.j <br /> j F.Ttoruporwo Phone <br /> cn`� 9. Deeionaled facility Noone and Sire Address 10, US EPA to Number G. Slate Foully&10 <br /> QSClem nEwbo" t� <br /> Z = H. Ftxiliy'•Phone <br /> am 00iiiiiiiiiiii, Ca sums <br /> Z. on inert 13, Tarot ►A. unitCnn5 11. US DOT Description(including Proper Shipping Name.Hazard Closs,and ID Number) No. Type QMgngty WI/Vol I. waste Number <br /> NZ a, Sk►e <br /> G• e .. . . EPA er <br /> O N b' Sola <br /> amtD E 10, . EPA/Otlrr <br /> N R <br /> T ` ® y= r Slga <br /> S ® 1` I <br /> EP er <br /> RS 3 $10 <br /> d, sem. <br /> �Pr Ar 'r .\ <br /> Lw <br /> U . '" EPA/Other <br /> U1 - • <br /> 12 A0111M.- <br /> J. Adddiorrcl ipl(Ons for Mate •titled, / K Handihig.Codes lar-odes West Abo" <br /> 0 1 S. Special Handling Ininuc6one and Addi,ianol Information <br /> Z <br /> Uj <br /> _ 96pelt' <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare 1601 the c.nleAls of this consignment arc fully and accumr.ly dentibnd obovo by proper ship�in0 name and am ctotsihad,pocbed, <br /> Vmarked,and labeled,and ere In all(&•peen:n proper condlllon for Inanition by highway according ho opP ieebb International and notions governmen)repvlotiont. <br /> If 1 can o larva quontiry generator,I comfy Ilial i have o tom In place,o reduce the volume and loeicity of wile gent reied ro the degree 1 hove damrmined I.be economically <br /> or practicable and the,I l ons wleered the�roellmble method aF healmant,storage,or chop—I turtinlly avail me which minimizer rhe tent and future threat to human Ireelth <br /> and the•nvlronm&nl;OR-if I am a smo I gvonlib'asnoralor,I have made 0 good lelth effort to minimi •y u.venerplI..and tele best wotia management mo,had t6ot is <br /> z avoilable to me andth n afford <br /> OPrinted/Typed No Signalure nl r <br /> Z <br /> W T 17. Trons onor 1 Ackna .meal of Rocoi t of Mol.de6 �j <br /> Yea <br /> oG 1 Pr ted/Trped Nem Q n r <br /> U.1 <br /> M w <br /> LU <br /> P <br /> U. a 18. Tran+ vAer Z Aeknewled smear of Real r of Materials <br /> O R Printed/Typed Name Signature Month Day Year <br /> s <br /> t"'n A <br /> U19. Discreptancy Indication Space <br /> Z F <br /> A <br /> C <br /> 1 20. Fee;Iily Ov,nor or Operator Certification of recei r of hoserd—materiel.severed by,hit monif.M.— tat noted in Item 19. /f <br /> T ,Iniad/Typed Nome t ^ ignprvra V month �Da� Year <br /> Y (Kf ��71 ((rJJYY� <br /> DO NOT WRITE BELOW THIS LINE. <br /> While: TSDF SENDS TP41S COPY TO DTSC WITHIN JO DAYS, <br /> DTSC 9022A 11/99) To: P.O. 80. 3000, Sacrometdo, CA 95812 <br /> EPA 8100—Z2 <br />