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late of CCfffomio--Env;ronnmPn"PrOdiOction Agency, <br /> ,-'mAPprov*dOm8No.2050-mg(E.pi,m9-30-96) 3 See Instructions an back of page 6. <br /> rust or reed for u"on elite(12-pitch)?ypewrifer. Np'�"'M of T—k 5ubStOnrft Control <br /> 1. Generctor's US EPA ID No, Manifest Document No. Socrornania,California <br /> UNIFORM HAZARDOUS 2 Information in the shoded areas <br /> WASTE MANIFEST Al Of is not required by Federal low. <br /> 3. GeWQ Ncre Address <br /> UNIFORM <br /> H <br /> d <br /> HAZARDOUS <br /> 2 <br /> RDOUS ;-1111116 US EPA <br /> WASTE MAN FEST F/Ii I 'I <br /> C <br /> 3 N <br /> 9 )X <br /> �)X <br /> 4 <br /> al <br /> 4 <br /> T4.7LG*r*rcrror s one <br /> Z Transporter 5 <br /> 5. Tron"cler I Company Nome 6. US EPA Number <br /> Pfk <br /> J, <br /> TrdnV6rter 2 Company Nome 9 US EPA ID Nu b,' <br /> 9. Designated Facility Nonve-and Site Address <br /> 10. US EPA ID Number <br /> Inc. <br /> pa I E�l I <br /> (510)23. <br /> 11. US DOT Description(including Proper Shipping Nome,Hazard Class,and 10 Number) I2. Containers 13. Total 14. Unit <br /> No T Quantity WI/Vol 1. Waste <br /> Hsi-'ax <br /> G Ty Vii! <br /> 0 <br /> N b. 51u1e V, <br /> E <br /> R <br /> A —LJ I I <br /> C. <br /> T <br /> R <br /> EPA <br /> d. stam <br /> Em <br /> -fix Udad Above <br /> _W500 4W� <br /> vy <br /> 15. Special Handling Instructions and Additional Information <br /> 1 7.1 i-,t <br /> 7' <br /> t Y- <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 /> pocked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> If I am a large quantity generator, I certify that I have a 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 /> threat to human health and the"viromment;OR, if I am a small quantity generator, I have mode a good faith effort to minimize my waste generation and select the best <br /> waste management method that is ovoilable to me and that I can afford. <br /> Printed/Typed NameSignature Month Day Year <br /> T- <br /> 11 ' Tronse2rtef I Acknowledgement of Receipt a(Materials <br /> I PrinteclL!pd Name Si Month Dory Year <br /> 9 <1 <br /> V, <br /> P zl <br /> 0 ..18. Transporter 2 Acknowledgement of Receipt of Materials <br /> T Printed/Typed Nome Signature Month Day Year <br /> 19. Discrepancy Indi<o6on Space <br /> f <br /> A <br /> C <br /> I Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T .ted/Typed Nome Signatul e_ Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> rSC 8022A (1/95) 3er,!r-,7crs who �oiarcioijs waste :cr c-, <br /> 'A 9700-22 produce cempieted copy of 1fi.s opy and senc: �L —ih, -"G jays.) <br />