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1.2//30/2A03 14:13 7077471927 UNIVERAL ErNVIRONMENA PAGE 02/03 <br /> Sfata of Cc�li6snia-;tEmironminiol Prvin[d�i,�on ASA <br /> ' Fdrni Appsova OMS R6."2050-4039 MKPp 4 940-M See Instruesiefis On back of page'6. ' ae ar,me U f o e Subsloncca fon'r <br /> Pieria print or,}ype.. Faun des gnedfu uS n elite 112.1sitch)lypewrifer....., . .,. ._ Socrdma5�o Ca[tlwnid v <br /> 1 Genvrefor's US EPA 1D No.-.:; fYldnifast boetmer!No. 2, Page 1 InFormarioq in tha'sl oded a reOS i <br /> iltJ1FORM'HAZARD4i15 nae req�mad ar Federal tour <br /> K M1 of <br /> WASTE MANIFEST : d <br /> 3 G <br /> or-, <br /> Name '" "'' y�,�/ -; p„� I� {FesrO«u[ry tNum6f/�r f►'�1 f�S4 Y`�ji „✓t <br /> 11JVQ Y V�,,:�y��. - .moi.• S,? w� y5 S 3"r - t2i�aW. <br /> Y 1 T i f -'r r /] 8 S3nNiCianetotcrs IR ti u 1, � 4 y� slF �}�4 �5�'v\ 35t <br /> ��Q+i rt• t ,� trr� -- y - L t r'S 5�. rr�'`�-� <br /> � ,,, - C�Stnl�'� nxporlel's Ib{Reserve j # � �'t >r,F•� �yR <br /> _ <br /> CV 5 Jranspart r,l Compo y 1-fano' - �- -i. + -! C sr• �', s,{ <br /> z, DCP <br /> Treiiaportets P.kwn -y sr,; �µ ,, <br /> O .. E SSoro-TtaM axle a f?[ aesrvad j 'L ` 2' <br /> m � 7 Transporter 2 Coimpany Nemo <br /> 5 <br /> n� F�aeisporfer'€Phon447'�ifr�_;ir'�°5, a 'r�l w ��a <br /> J - <br /> a 10. US EPA ID Number <br /> u G Sral aerltty s ID r } -h r} <br /> Q 9, Desig pled oci' No at}e Ad�rey 4 J * r ilr <br /> 1-?KL f�/} 1�.��.�.t�- }fes F,�,fil�!s-PKona ,;ti,,x�r �.t �- � i,r� 1� 1:�•u <br /> rxz- <br /> rr <br /> W <br /> 12. Cnntornarz 13. Total ld. lSnit <br /> 1,M1US DOT Description[includ nA Proper Shipping Nome,Hd-ard Clots,and ID Numbar) T 7e Ouaniity WI/Vel I ;Waefe NumS�ir r* <br /> E-- 'Other6. i.,cr • <br /> chi= <br /> Co E Q ;` ppAJOtI e <br /> A State:. 5i <br /> oT <br /> e, EPA/Qtfier:,.` <br /> 0o O <br /> w d, <br /> ua i <br /> U a K ticndl ng Cad for was fes[r>ted Abe e y - iS <br /> rf'l5dd hor<aFl7escnptronr for Marerlals sated Ab�s�°t � � i r Y" �,"` 5 6 5, +. <br /> '- <br /> H c <br /> 4 M <br /> d <br /> � ,tiiyp ¢�o�yy-s�•-� +���r ` 'l' S �.�hir j'-0r -� r , ~A A��y 4 f..rLr��1.,� .�y+7"f`��� I`{it ,�,r '';ids` •M.�r * �i �'5 1 <br /> z <br /> 0 �•15. Spec:nl Handl�ng7name and or.lnstrn <br /> Lu <br /> 4 <br /> 16. ma ked aQnd[ab ad�FCA I and pa n all rerpe<ts in proper Gond l:n <br /> for ka uporf by n 8hwpy according to opp cdabl enin lemellonal aP d ro na!'oer htol goYe nmenl re®vlatiian.Fcd,pocked, <br /> U <br /> .J. If 1 am a 1aT$a gvanriry 8oneraiar,I tort Fy knot E ha.e o program in place to reduce the vetume and toxicity of.rade generated So the degrde i have deh+rmined c t o mato,,Cally <br /> if I on ble and that l hartr selected rho pra4eta6la method of rreatmenrraloraga,or disposal everently arailabla to me which minimizes the preran4 and Sa9cre ihrear to 15utnen health <br /> :,and rbc environment,OR,if I am a small gvanlitr generator,1 boyo made a goad faith effort to minimim my 5rra¢}e generation and salad the best wosM maAegcmenr mobbed 115er is <br /> a ff <br /> a.vilabla to me and that 1 can afford. 1 .fMonFh Day - Year <br /> Q <br /> FTinted/T ed Na ma _ I �}'�tlgt} <br /> 1' DIs <br /> :tj <br /> Z .. r1 <br /> sip <br /> Ur J 7, Trwu'a Acknowled emonrof Recei +ef Materials on a6Y YeOi <br /> 5ignotura /`. ' <br /> ed i Pr , iSan <br /> Lu .5 .. v� .,. .: <br /> w21 <br /> 0 O Tron rter 2 Acknowledgement of R i r of Mater al; Yeor <br /> f Ant}, D� <br /> TPri Ied/Trped Name Signon,ro •- <br /> w <br /> rr! R <br /> { f,J 19, Discrepancy Indication Spate - <br /> F <br /> A <br /> C <br /> I - <br /> 204 Foci ti OYmer or crator cc,sc,man of retrial of hacardam materialr ea del Ibis Mani feml eY ee t as Holed in Stem l4. Month Day YeC <br /> T it nted/Trpa4 name Signature <br /> Y <br /> DO NOT WRITE BELOW THIS LINE, <br /> White; TSDi SENDS THIS COPY TO DTSC W17HIN 30 DAYS' <br /> DTSC 8022A.0/99? To: P.O. go. 3000, Sacramento, CA 95812 <br /> EPA 9700-22 <br />