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-}Stall of.Califomie--Emir mee nal PMacrion Agency <br /> Form Approved OMB tlo.2050-0079(Expires 9-]096) Sae Instructions on back of p 6. Dep.mnem of mxk s.bstarc«e«erol <br /> Rwse psknRtRFptP Farm desiprod!or ase w eiro(12pis.,)type sacrament.,California <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS r b net required by Federal law. <br /> WASTE MANIFEST n U r rj013 <br /> G (i ..; .f <br /> 7. .tar's Name ail'mg Address 1-r i - me tixmber.� � , ✓.(' <br /> G`"°�lewon <br /> �T^ �' ' <br /> 4 `V I •� �`''�, / & 516te z:ID I <br /> n <br /> N b $�1T!Sat1 r <br /> A. Generator's (A 21 '7I <br /> 4j q -+.3 <br /> 3. Transporter,1 Company Nana 6. Us EPA ID Number C. Stile T ;fps ID <br /> m ' <br /> i :I 1 D. T, {510 235-1393 <br /> Q 7. Yr..parter 2 Company Name R. US EPA ID Number E.'. ^ID o - <br /> T <br /> Q 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> • � F`iTt1 t�IJ).T�„K1fIZP1lf-dI B�P,.i '' <br /> •O _I)3 33 1*C hi H Facility's,Phone <br /> 1s Q "r r ^y fI ; i1t ' 33 <br /> 4-168 <br /> U <br /> 12. Containers 13. Total 1A. Und "> f <br /> ' Z 11. US DOT Description(including Proper Shipping Nome.Hazard Gass,and ID Number) No. T Guantity Wt/Vol 1 WasteNsnnf`en"3` <br /> Z Stale ='-t <br /> pc? 4a3te ;Iamlai>Ie I.iyu.iJ. t) 6 'Ga34•lit to i 3, <br /> 3 EPA dlNij <br /> o <br /> G <br /> ser E 'Jtd19 • ;.Zi.i.,GOf1I . D018 OO ) T ”" t7 ! � i <br /> ao N b. <br /> E <br /> k <br /> R <br /> T <br /> R EPA/ <br /> w <br /> r d _- Stab,... <br /> Ui._A:li . SEtt?-_44$fNl ;1gq <br /> Profile 3014"", `': <br /> K. S«waw Listed Above <br /> clI'` ' y. <br /> . '.•..k .,n �a.L-- lar +s1�" <br /> O 15. Special Handling Instructions and Additional Information <br /> ... <br /> W <br /> F <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment arc fully and accurately described above by proper shipping name and are classified, <br /> Qpacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national gowmment regulations. <br /> U <br /> If I am a large quantity generator,1 certify that 1 have a program in place to reduce the volume and toxicity of wash generated to the degree I have determined to be <br /> J <br /> economically practicable and that I haw selected the practicable method of aeateeM,storage,or disposal currently available to me which minimizes the present and future <br /> Q. <br /> threat b human health and the a Amenent:OR,it I am a small quantity generator, I haw made a good faith effort to minimize my waste generation and select the best <br /> ad waste mrogmm&method that is available to me and that I can afford. <br /> O Prkdad/Typed Name Signplure ( Month Day Yearl. <br /> Z T 17. Tran r 1 Acknowledgemat of Receipt of Materials '� r <br /> 0 A Primcl/TYped Na'ne 1_/ &gnaNre I/ " /v'/ Monnh. Day Year <br /> F P <br /> w 0 iB. Transporter 2 Ack"wledgemm of Receipt of Materiak <br /> sy t Primd/Typed Name Signature Month Day Year <br /> O it <br /> V) 19. Di«repancy Indication Space <br /> U F <br /> A <br /> Z C <br /> — I <br /> 20. Fooility Owner or Opmaivr Certification of receipt of hazardous materials co red by tit' manifest a noted in Item 19. <br /> Si /� = ( / Momh Day Attar <br /> Y Printed/ji'Red NmJr' I 9^^nr^/. / <br /> f. ---- <br /> DO NOT WRITE BELOW THIS LINE.. <br /> YellowTSDF 5'cNDS 71 f0 - <br /> tGenerat.o who <br /> DTSC 8022A (1/93) produce ompieted c..ev of thl; -.apY cra _..- _ __ .....n 30 days) <br /> EPA 8700-22 <br />