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Siawof Californio—Environmernal Protection Agency <br /> Firea Approwd oms No.20-44-=9 Expire,9.30-96) See Instructions on back 1we 6. D,,enneen of T..,c Subamne.Camrc <br /> Fl. rim or". . Form dig—d far-m-'Jm`(121, 16.1 son.aero.C.1ifeni. <br /> Manifest Devere 2. Raw I J.— <br /> ,:::7 <br /> required by <br /> dusclod oras <br /> UNIFORM HAZARDOUS 6, Federal <br /> WASTE MANIFEST Generator's U$EPA ID No. of <br /> 14,i 0 <br /> 3 Name and Mailing Add. <br /> 'R- <br /> i <br /> IWO <br /> un. 9-2330- ESTE- <br /> 7— <br /> C`1 <br /> Q1 A. Gervirree"Ph �/ X WISNOWRI <br /> co - <br /> 9 5. Trmrmo�I lumber - ------ <br /> a? D. <br /> IC R qH'1-6 14 <br /> 7. Tnerpciree,2 Company No. 8. US EPA ID N..bon, <br /> < IRM <br /> U <br /> 9. Deligromed facility Nome and Site Address 10. US EPA ID Number <br /> 0 'U, <br /> J!!: Fbamv— <br /> < I <br /> 1 12. Carmine. I 13. <br /> 11. US DOT Description(including Proper Shipping Nome,flared Clan,and to Number) No. 1,Type Q..T:� 1w'-'/UatDescription 1. woa., <br /> EPA <br /> , I <br /> 0 <br /> N b. Stale <br /> R I I EPA -LAI <br /> T C. <br /> 0 <br /> R .L11762-�% <br /> z d. <br /> U <br /> j <br /> ...... .... . ..... <br /> za sem.- <br /> z <br /> O 15. Special Havedlim Instructions and Additional Iniccroodkom <br /> r <br /> < <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare,the the contents of jh6 ammignmonot are fully and accurately deecribed eboee,by proper shipping name and are classified, <br /> packed,marked,and labeled,and me,in an nmpees in proper condition for transport by high my cc,cedb,to applicable immem.I and national gowmmrnf regulafficen. <br /> U <br /> If I an . kww quantity generomer, I certify the I haw a program in place M reduce the volume and toxicity of enwam generated to the degree 1 haw detemieed to be <br /> moonceric.Py Practicable and the I home&.1ected the practicable n.+.d of treement. Ocenage,or disposal currently available to.which minimizes the PrmueW and hftme <br /> UO flueel to K.health and the eminamment,OR,9 1 en a wall quardity gamerever, I have rade a good fed, effort to numeenize-my varve generation and select the best <br /> Qc worts marmeorree mailed the is ovaaabk to.and that,I can afford. <br /> 0 PrietedlTyp.&N. n Month Day -Y., <br /> Z 1 17. Trans I A�kniedReceiptp2ror gememe ofReceiptof Manorial, <br /> A <br /> It <br /> ` Month Day Yaar <br /> PC <br /> w cipt of Material,Nary Melth Day year <br /> 0 1 Ti�� <br /> rinited/Typitel am. <br /> w 19. Discrepancy Indian i. Sp. <br /> U P <br /> . A- <br /> z <br /> I <br /> k by this mcmifea cW w need in N.19. <br /> 1 20, Facility Onmee ar Opencoar Certification of receip,of hazardous mwerials cowred <br /> 03- PH . /Typd Name S-7dure Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DISC Fl 2A (1/95) Yellow: GENERATOR RETAINS <br /> EPA 8700—n <br />