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fare of Colifornk---En`ironmental Pratect;on Ag—,y <br /> arm Approved OM13 IVa.2050-0039 MxPiras 9-30.96) See Instructions on back of page 6. <br /> lease P ' form d°srprwd for eI �' I7'P <br /> era on elite T2 rrch wrrler Deparmenf of Told Substances Control <br /> e <br /> Socromento,Cnliiomia <br /> UNIFORM HAZARDOUS I. f'eneraMr i U5 EPA ID No. Monifesf Document No. 2. Page 1 Information i the shaded <br /> AIL <br /> areas <br /> WASTE MANIFEST /� /�%3 i r /s ! c� �) ( is not required by Fedcral law. <br /> 3. C.re ator's Name p�d Mailing Address ..r_,. <br /> t�V-Cdl J �-ri:, �' J_ �' �'h Humber {y - <br /> � <br /> _ <br /> A. Generator's Phare ( v� <br /> 5. Transp*eter 1 Company Name 6 <br /> US EPA ID Number C. <br /> .:.>_ : ' ;_:�'.=r I't'�,r>,:;t t.., •.rl ac:l-i�, _� _. i ', ',� 1 j � �,,� r, ���,Q� 23S--1393 <br /> ' 7,'Tranaporter 2 Company Name <br /> f3. US EPA ID Number .er �- <br /> t n <br /> 9. Des grated facility Name and Site Address 10. US EPA ID Number <br /> _ r r,•:.v <br /> � t'•=fFt� 1.Z '';.� <br /> ' � �'�.3-. �•f..;�j 'Ens• i* ;. EE 'r1y�j.Y�t. <br /> fr. ( r t - tif'lnone,r3--•' t ^rd.Tli�rTgyT. <br /> Barr' <br /> ntainer '�"^�-=•'t ' <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Numb12. Co13. Tatai 14 <br /> crJ . Unit <br /> Na. T (Ouantity WI/Vol L�-Vlfaite� <br /> a. <br /> .:r_ �1��,r W '}.ctTTT1+�3.i.:h_ I.i._{�1i.;. t}.�.� �;�:,•1 irlC .;, `,;�,., :, <br /> G <br /> rA <br /> E 'T+1FA ,T .I1Oli� . {�i!1� CU I i (� i :i ri a :_ <br /> R <br /> A I <br /> T ,S1e11► _ <br /> O <br /> i Elt' <br /> d. <br /> 4 <br /> 3Pft hrs'sg"4 51u1e <br /> a — w <br /> Profile 30197`, E.P:"l r <br /> s h' for cats luleMda,Abo•iv y <br /> t. r TL a� rs <br /> 745 Yty_ <br /> 15. Special Handling Instructions and Additionai Information <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 notionol govemment regulations. <br /> If I am a large quantity generator, I certify that f 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 environment; OR, if I am a small quantity generator, I hove mode a good faith effort to minimize my waste generation and select the best <br /> waste <br /> management method that is available to me and that I can afford. <br /> Printed/Typed Nome ` Sig re / 1 Month Day Year <br /> ti i <br /> 1/1t)Ax Lit `—' <br /> �— <br /> A17. Trons r 1 Acknowledgement of Receipt of Materials <br /> A Printed/Typed Name Signature �� ,mss Morth Day Year <br /> r <br /> i <br /> 0 1 B. Transporter 2 Acknowledgement of Receipt of Materials <br /> K Printed Name Si rotate <br /> T /TYf 9 Month Day Year <br /> N <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> Ifacility Owner or Olaerctotr Certification of receipt of hazardous materiaro <br /> ls co"red lay th' manifest a noted in Item 19. <br /> YPrintedr[ycd Nartiet I Sigtsafyre I/ ! j Month Day �aar <br /> % / f '/ <br /> DO NOT WRITE BELOW THIS LINE. <br /> ye!ow Ts--; <br /> TSC 8022A (1/95) pr_� ce compierF c-r.. ci rh s -oc _:.� _ 3G acys <br /> °A $700-22 <br />