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I <br /> • I <br /> Formarlm <br /> nvad 4nsd.Nn.2050 0089;Etspires -�0=99f see Instructions on back at g a 4 DePent of Toxic Subeloneee Control <br /> rl4y.e'prApprlet or typo. Form designed for use on stile I12-pilch)rypewriler. p7 • (� s Saceamenlo,Calliornio <br /> 1. <br /> Generator'r US EpA Ip No. Manifest Dotumenl Na. �. Page 1 Informellon In Iha shaded areas <br /> UNIFORM HAZARDOUS is nor requirad 6y Federal low, <br /> WASTE MANIFESY I� S . G V' L f 3 of <br /> 3. Generator's Name and Mailing Add <br /> rai - { <br /> Av 12 <br /> CD <br /> cc it. MAIO, <br /> d. Generotor's Phone I�]f� } �j s <br /> 7& L1 — [7. ��•�(.I'�f,v � <br /> 1 � z <br /> ev <br /> S. Irons o.L a Nam a^4tSP°rf' itJOEk.`&&V V7a <br /> ao <br /> o� 7. Tronsparter 2 Company Name B. US EPA ID Number <br /> �Q <br /> tl ��7yprlyfq�Fyc �1�g1+pS�yR� 10. US EPA ID Number <br /> ](7 d 4 LU�J i IY 1 V.7 <br /> 255 PARR BLVD <br /> _Uo RICHMOND+ CA 84801P IAI41616131912 <br /> 12. Conlainers 13. Tolol 14. Unit <br /> 11. US DOT Deeerlptlon llndudlnp Proper Shipping Nome,hazard Clau,and 10 Nemberf No. Type Quant WI/vol <br /> )1z WMTE EMPTY ST—O — <br /> AGE TANK <br /> Non-RCRA hazardous waste solidQ Y 2 P <br /> mE <br /> N b <br /> m E <br /> R <br /> a T <br /> OD O <br /> •- R <br /> Uj <br /> d <br /> W <br /> L <br /> W <br /> N <br /> Z <br /> A <br /> 4 <br /> In <br /> W <br /> ai <br /> tirira�P`l <br /> wnEll,handlln 4. -OP51 <br /> SITE LOCATION: ,�i r t IV �@��p..,,r� <br /> 24 Hour Ehlergency'Telephone Number- '� � � �'hae-�-f�.c C.}W 2a Hour Emergency Contact ' ERCW 1T1 <br /> 16. GINARATOR'S CERTIFICATION: I hereby declare+her Iha coverers of+his consignmenS ora fully and accurately descrl6ed abate by proper sMpflng name and are elosrlflod,packed, <br /> marked,and labeled,and are M all respects In proper condition for fronspon by highway accardin8 Io applicable inlernallanol and notlomo government eegufadons. <br /> iF I <br /> am o large quoriiy generolor,I certify Thal I have a pro rem ie place to mcfute she volume and fo>iciy of wade generated to the degree I have determined to be aeenemleallyy <br /> 401praeficable and Thar I have telecled the practicable method o treatment,rlorogf,or disposal currently o radgbto to me-hick minlmlus Iha present and future threat to human healih <br /> d' <br /> and the anvironMehl;OR,If I am a small quanlly generalor,I have.made a good faith effort to minla+lae my waste generation and select the,bear wave manopement method shot Is <br /> available to me and that I con afford. <br /> 9rinledlTyped ams Signalahis <br /> •month Day Your <br /> (s Q f Y <br /> (� BL17. Tram lar 1 fcnawled emaat aF stet I of Melarlals <br /> Aed/Typed Nome 51 aalur� g Month Day Yaar <br /> o ty Qpane y ed/Typed Nome Signature Month Day Year <br /> Q <br /> R <br /> V F 19. DI creponey Indlcatlan Spaces <br /> Z <br /> A <br /> C <br /> I <br /> t. =, ,; <br /> rot rtJic i; nof recel 1 of hoxordpue materials cava this monist eats t n rod in Its 19T Y 's yyy Signal <br /> / � Month Day Year <br /> L/ r <br /> DO NOT R E E1OW HIS <br /> DTSC 60224 111991 W'.dte: ISUF SEND5 7H;5 COPT 'rt.) 11'fSC 1yFrH114 30 DAYS. <br /> FPA 6704-22 r,+ lu; Y.O. BOX 3000, Sac•rm,fE,do, CA V5812 <br /> r� i i i 1 0 K cr.nr._ofic-.cn7 I411At, r rrr l .rel • onu <br />