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sla,.al C f.,,WE-Wor ej Proration Agerry So* Instructions on back -age 6. Depcow,�of Toxic Sub��Co,e,c <br /> F�rrn Approved OMB No.2Q50-,X"pq*.9441696) <br /> M.PV* type.. F.draiwd for Calif.. <br /> R.`12p� 9— <br /> I. c;e es LI <br /> aloS EPA 10 No. Maaifev,D. .. 2. page I.f. .Snon the shaded aem <br /> WASTE MANIFEST of <br /> UNIFORM HAZARDOUS I ;q I I ` I iL �mt rewired by Federal law. <br /> 3. s Name and Maifing Address <br /> 4. G...Vws Ph. <br /> 9 5. joaraporter I Cpwpwny lsloae�_ 6. US EPA ID N%,ader <br /> I� WW <br /> t <br /> 7. Trave"rter 2 C..pany N— 8. US EPA ID Number <br /> U <br /> 9. Dp7m.amd Fodrdy Nene and She Addr,rrn 10. US EPA ID Number <br /> Ed chnt,(o 1,CA. 94-,1+1 <br /> U <br /> 11. US DOT Dwripriian(indudina Proper Shippin Name,Hazard Clam,oad ID Number) 1 12. C.rt.irwrs 13. Tool IA. Unrt <br /> I No. TQuor1 1, 1 Wf/V.I <br /> ri_J-v <br /> E F;, <br /> N b. <br /> E <br /> R <br /> A <br /> T <br /> 0 <br /> R <br /> W <br /> Z <br /> 0 <br /> Z <br /> 15 hoodlitv ia.and A&Waml lnfaenaion <br /> f <br /> x­ -.:-- - <br /> < _F` ur-,­ —h— in,-7 <br /> r lvt <br /> ..t Na LW <br /> Z Y_ <br /> C. -4 Hi. . <br /> 16. GENERATOR'S CERTOWATION: I hereby dela,that the torrents of sten ouigm are hilly ad..rarely des,ibd ab.by proper chipping name ad ore d ..ified, <br /> pocked,marked,and labeled,and are in all re,,,w,;ia proper cad'eian far,tronspor,by highway moorcRmi,to applicable matemalkwal and normal goremmarr, <br /> If Ian a large word0y generator, I cw*that I ho,re a progivem in plea to rvdrte the%,akeae o toxicity Of waffle generated to the degree I have determined to be <br /> econo kllly prockable ad that I hero selected the practicable medd of fraahrrene,vfcage,or disposal wnw*available to ere whkh minimize,the p emi and firtare <br /> rail threat to feam h..bh oad! OR,6 1 am a wall wm*ty gaaaaiorr, I have node a good faith effort to minirmize my waste generation and mled the best <br /> ast. .0.ed that i,. .1 We tome ad thaa I can aHard. <br /> O — Signaftmre.z :YewPi /Typ"16. <br /> Le <br /> U AfLe r r v <br /> v ..✓I x <br /> Z T 17. Tayprler of Receipt of Materials <br /> It 346.owledoeveat <br /> • <br /> 4 M..Ih Day <br /> 0 pmp <br /> 14., t Year <br /> Lj <br /> L2 1 1 <br /> 0 ISL T 2 of of Maftk <br /> T P i ft /Typed No Sigaahere morth Day Y. <br /> 0 <br /> W 19. D6avpxy krdcavn Space <br /> < <br /> U PA <br /> Z C <br /> �. C��.opemomr rarrkficafian of i.&of 6...1..maawh cowered by this oandea esorpt m noted i.her. 19. <br /> Pndd[Typed Nees <br /> �Si9rar"r" <br /> DO NOT WRITE BELOW THIS UNE. <br /> OTSC iM2A (1195) Yellow: GENERATOR MAINS <br /> EPA 6100 72 <br />