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ae of Cafibernio--6nvironmantd Wgrrttion Agency <br /> •m Appro9(C pines 9-3496) See Instructions on back of page 6. Department of Toric Substonces Comrol <br /> •me print Form designed for use on&fire(12-pitch)typewriter. - t Sacramento,California <br /> UNIFORM HAZARDOUS 1' Generator's US EPA ID No. Manifest Document No 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST Jf t <br /> is not required by Federal law. <br /> t " r� u of <br /> Generpigr' ood115q¢ling Address v+ <br /> i�"?i�I�(`•�s `7 <br /> SII <br /> d. Generator's phone ( .F'.� r <br /> 5- Transporter 1 Company Nome 6. US EPA ID Number Ca h e <br /> O'TrdMpOt6W.C. <br /> 7, ronsporter 2 Comparry Name 8. US EPA tD Number <br /> 9. Designated Facility Nome and Site Address 10. US EPA ID Number i 3 <br /> t - •1. 1� I "'f '� f - ] :LAY s��JrV'�d'i L7��L ri <br /> A,Ta <br /> 11. US DOT Description(including Proper Shipping Name, Hozard Class,and ID Number) 12. Containers 13. Total ]d. Un4 :;•-:•S,�Y_ <br /> No. Type Quantity Wt/Vol <br /> a �,-.. _. - -.. .L-,t.,,-;_ rd:.�=tr- - -- ...1 'µ•'yr- *�¢ <br /> N b- s <br /> E <br /> iR <br /> T k l a <br /> R i �'. <br /> d <br /> 4WWI .k.�& ; <br /> i c A6axr ;a' <br /> M1, �X <br /> (` g ^( C.f": - .L.: - <br /> 'MAY 4 I v�' r i �• •• � r �� <br /> -i., ^' -J�'�`C•-�j+hA'rt:a .tYS=';Xr-'1.. .. <br /> k15. Special Handling Irtstructions and Additional Information <br /> :fix :?` i?te_. GC.r " _ jlrTfA: <br /> 6 G <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, <br /> packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> s <br /> If 1 am a large gvon ity generator, I certify*or$ I hove o program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> erator, I have made a good faith effort to minimize my waste generation and select the best <br /> threat to human health and the environment;OR, if 1 am a small quantity gen <br /> waste managernew method that is available to me and that I can afford. <br /> a Printed/Typed Nome [ Signature Month Day Year <br /> I 1 Tran rter 1 Ac wled emenT of Receipt of Materiaf <br /> � RMonth Day Year <br /> I F Printed/ Name <br /> Name Signature / /! l l <br /> t r 5 <br /> p 18. Trans rtftrYA3knowled ement of Recei of Materials <br /> Month Day Year <br /> R Printed/Typed Nome Signature <br /> R <br /> Discrepancy Indication Space <br /> s: F <br /> J A <br /> � C <br /> 20. F itity Owner or Operator Certification of receipt of hazardous materials covered b this manifest exce t as noted in Item 19. <br /> T Printed/Typed Name Signature Month n Day Year <br /> Y � b <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow, 15DF IFN .S 7H'S -Yw .G vNE4.�TCP r.?;- - <br /> ;Gerararcrs .ahC ;V C.+S,r hczcirdous wcs}e ?cr <br /> 3T$C 8022A (1/95) p•raa Vc.e completed ccpy of this copy arc :end to _ ..••1',r• 30 :'Qys <br /> cPA 8700--22 <br />