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,o—Environmental Protection Agency <br /> reB No 2050-0039(Expires 9 30 991 See Instructions on back of page 6 Department of Toxic Substances Control <br /> Form designed for use on elle(12 pitch)typewnrer Sacramento California <br /> NIFORM HAZARDpUS 1 Generators US EPA ID No Manifest Document No 2 Page I Information in the shaded areas <br /> is not required by Federal tow <br /> WASTE MANIFEST <br /> U PO Iq ' ir3 1< 7 3 1 of 1 I <br />�erat r s Name and Mailing Address Do,P,-4.-p-r,? I.q" A State Manifest Document Number 2074347 <br /> 8 I <br /> 4t IL: <br /> '} ,a,,,- B State Generator s ID j <br /> erator s Phone [rat-sf I �j37-0771 ;E <br /> sporter 1 Company Name 6 US EPA ID Number C State Transporter s ID[Reserved] p <br /> C, v j, �} D Transporters Phone <br /> � �{ J C,11 <br /> sporter 2 Company Name B US EPA ID Number E State Transporter s ID['Reserved] I <br /> e <br /> { F Transporter s Phone <br /> I ] <br /> esignated Fo4rlity Natpe]nd Site Address 10 US EPA ID Number G State F�Jtty s ID f <br /> b*� f rL r- TIw,A_r icr ILIC)IuA II q1 C1 61 91 <br /> CtL1C Ice,.S H cility s Phone It <br /> r s <br /> I1.rr Dr., CJ = q0. <br /> � <br /> 5 12 Co oirLr4 13 Total 14 Unrt ' <br /> DOT Description{including Proper Shipping Name Hazard Class and ID Number] ¢ r <br /> No Type Ouanhty Wt/Vol I Waste Number <br /> 'ZZ-j. Ifio G�,�jE_ r-11V[r State; f <br /> � .0 j <br /> � 1 1 G"r� r (7EPR/Other <br /> l <br /> State t <br /> , <br /> EPA/Other j <br /> I State <br /> i <br /> her <br /> State State e <br /> E <br /> EPA/Other E <br /> escnptions for Matencls Listed Above K Handling Codes for Wastes Listed Above <br /> a � � b I <br /> -i <br /> t c d <br /> 4 <br /> r I <br /> ual Handl n Instructions pd Additional Information <br /> A �t [apt-� ► ; Z <br /> 537—U7-7f '►c � <br /> l.,vft ^� Gy <br /> P![Mc(r u f?I-s 1 14,T Cd(r rr L r (P*,/ ft <br /> 114on 04 <br />,TNERATORS CERTINCATION I hereb declare that the contents of this consignment ore Full and occurately described above by proper shipping name and are classified packed <br /> narked and labeled and are mal#respects in proper condition for transport by highway according to applicable international and national government regulations E <br /> Uccib�'. <br /> m a argequantity generator I certtfy that I have a program En place to reduce the volume and toxic of waste generated to the degree I have determined to be economically <br /> and that I have selected the practicable method of treatment storage or disposal currently ova%ble to me which minimizes the present and future threat to human health <br /> nd the environment OR if I am a small quantity generator I have made a goon faith effort to minimize m�waste generation and select the best waste management method that is <br /> vodabie to me and that?can afford <br /> Typed Nome f� 61/r, <br /> Signature � ff Month ay Year <br /> A' �` y U , <br /> rons orter 1 Acknowled gement of Recei t of Maier Pais t� <br /> d/Typed NameL �� )ZO <br /> /� Signoture ' l t r Manlh DayYeor✓ ✓ fr1�L� [/ v <br /> s orter 2 Acknowled ement of Receipt of Materials <br /> d/Typed Name Signature Month Day Year <br /> I <br /> I <br /> repancy Indication Space F <br /> Owner or Operator Ceriih ❑tion of receo,of hazardous matenols covered is nifest except w noted in I 19 r� <br /> N e Signotu Month Day Year j l <br />' DO NOT WRITE BELOW THI L <br /> i <br /> "el,ev T5D- SE DS T^il5 COPY TO GENERATOP WITHIN 30 DAYS <br />/091 (Serercimr woo submit hazoraous waste for transpp#t�tY > state II <br /> I proeuce comoietec,ccpy of tnis copy and send t 30 days) <br /> �Y } <br /> ^'1Rr h <br />