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- <br /> State of California—Environmental Protection Agency Qr <br /> "j <br /> Form Approved OMB No.2050-0039(Expires 9.30-99)671 See Instructions on back of p0 6. Department of Toxic Substances Control <br /> Please print or type form designed for use on elite(12-pitch) her. Sacramento,California <br /> UNIFORM HAZARDOUS erator's US EPA 10 No. Moni est Document No. 2. Page i Information in the shaded areas <br /> WASTE MANIFEST Q" �'` � is not required by Federal low. <br /> Q js of <br /> 3. Generator's Nome and Mailing Address © A. State Manifest Document Number <br /> ®,mss , �,,�,,�. 23496738 <br /> p L®� 11. Slate Generator's ID <br /> Ln A. Generator's Phone ,J J 1 <br /> P <br /> STransporter Company Nome —J 6. US EPA ID Number C. State Transporter's ID[Reserved.[to <br /> - <br /> 1]V�8e1\RGR 11LL9T�+ AT A 11131216 <br /> r� L �s An <br /> 0O SEMCES C A D 9 8 2 Y 1 V 2 6 Z D Tiansporler's Phone 510/49g--44 O <br /> T 7. 8. US EPA ID Number E. State Transporter's ID[Reserved.) `� <br /> CO- $ N ION & <br /> M� REMIATION, INC_ CAD 0 6 3 5 4 7 9 9 16 F.Transporter's Phone <br /> Q <br /> U 9. Designated Facility Nome and Site Address 10. US EPA ID Number G. State Fd ili a <br /> tD a 21ST CENTRURY, EMI <br /> a)Z 2095 NEWLANDS DRIVE EAST H. Facility s Pho <br /> b-p FERNELY, NV 89408 N V D 9 ,8 0 8 9 5 3 3 8 175-575-2760 <br /> V—' f 12. Contoiners 13. Total 14. Unit <br /> ill. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantify WI/Vol I, Waste Number <br /> Z <br /> stale <br /> U .s t� <br /> 3 G 3r (L l EP ,Meer <br /> o N b' t/ State <br /> co E <br /> -4 R EPA/Other <br /> v A <br /> o <br /> State <br /> T <br /> m0 <br /> R EPA/Other <br /> CC <br /> LU d. State <br /> t— <br /> Z <br /> V EPA/Other <br /> w <br /> J. Addition I Descriptions for Mot rials Listed Above K. Hand' Codes for Wastes Listed Above <br /> Z la j7.4o'� ( b. <br /> vai 1b <br /> owc 11C c d. <br /> Q ld <br /> 0 15. Special Handling Instruction sfand Additional Information E_R_G it <br /> Ila_ <br /> Z 24 HOUR KK MENCY CONTACT:PHILIP INC_ $ SOARES llb_ <br /> = WEAR PROTECTIVE CLOTHING�� 321-10 SITE: 1 lid_ <br /> t- <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment ore Fully and accurately described above by proper name and are classified,packed, <br /> Umarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and notionoper shipgovernment regulations. <br /> —J—+ If I am a large quantity generator,1 certify that F hove a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be economicall <br /> yy <br /> a practicable and that I have selected the practicable method of treatment,.storage,or disposal currently available to me which minimizes the present and future threat to Kumon health <br /> and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> Oavailable tome and that I can afford. <br /> } Print /yped Name Sign Month. Day Year <br /> U L <br /> Z <br /> w T 17. Trons o Acknowledgement of Receipycif Materials <br /> w p <br /> Printf d/T Name Signature nth y Year <br /> w <br /> S v <br /> U. 0 1 . TrAtporWfAceipt of Materials <br /> 0 T rioted/Typed Name not re OMonth Day Year <br /> wE <br /> V) R <br /> V19. Discrepancy lndic;ii;n'3foce <br /> Z F <br /> - A <br /> C <br /> I <br /> L <br /> [ . Facility Owner or Operator Certific ion of ecei tof hazardous materials c vered by this anifest except-os not tem N. <br /> T Printe 'ped Nome Si cture Month Day Year <br /> Y I4 <br /> DO NOT WRITE BELOW THIS LINE. <br /> White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 877000--22 <br /> DTSC 0 (i/99f To: P.O. Box 3000, Sacramento, CA 95812 <br /> I <br />