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Stare of Californio--ernvlronmentai Protection Agency <br /> Form Ap roved OMB No.2050-0039(Expires 9-30-991 See Instructions on back of page 6, Department of Toxfe Substances ContN <br /> Please print or type. Form designed for use on eilte(72-pitch)typewriter.typewriter. 51� Socromenro,Catlfornio <br /> UNIFORM HAZARDOUS <br /> �-T. Generator's US EPA ID No. Monifeat Docvmenr No. 12. Page I nfermerien In the shaded areas <br /> C, Uis not required 6y Pederal low. <br /> WASTE MANIFEST aF <br /> 3. Generalor'a Name gy1�d[�pt m Add ss <br /> •-�/4 Z�V #( ,.r fPT1Yi7�TiYp''/tai InJJI � Kilrpl' <br /> In <br /> ,n A. Generotar'a Phone (� I �jl� '�s/ t,� 1 rJ 0.x ta,j rc a „ t J <br /> ,1 r <br /> CV 5 Transporter 1 Company Nome 6. US EPA ID Number S Jfry,:! r 1� Jsi krl t <br /> G7 ��n►nn\�.^nr\evnl:n�1r le!►s+lese .^ r% � �! \j U1 713 <br /> y iM VIVW VUIIII Vl g1UV0\i lep � <br /> O4 1 <br /> 7. Tr neponer 2 Company Name e. US EPA ID Number 1 <br /> J <br /> '�••IIJJTT Q, I t c It a 196YISTRIES 10. US EPA IJ Number <br /> L <br /> 238 PARR SLVO <br /> pyo RICHMOND CA 94801 A 3 2 <br /> .fly p 12. Conlainere13, Total JA, Unit <br /> U 1 t. US DOT Description(Inelvding Proper Shipping Nome.Hazard Clogs,and ID.Number) No. Ouanhty Wt/Vol <br /> Lly <br /> VVASTE EMPTY ST0RAGE ;FAP4l <br /> 3 C NON KRA HAZARDOUS WASTE SOUK p a l d <br /> E b <br /> o N <br /> oWo E <br /> e A <br /> T a <br /> O <br /> R <br /> CeW <br /> t\V` U <br /> W <br /> LAll <br /> N <br /> O< <br /> 0 1 S. Special Handling Insrrucrions and Addlilonol Informotion <br /> z 'blear proper protecthie equipment while handling. Weights or volumes are approximate. <br /> W 24 dour emergency telephone number: Ldp yy� <br /> s 24 Hour emergent contact: R,c,,Ar DOT ERG#171 <br /> 16. GENERATOR'S ClRTIFICATION: I hereby declare rhet the contenls of this conelgnment ore Fully and accurately described Octave by proper Ihlpping name and aro classified,pocked, <br /> rnorked,and labeled,and aro In all reapeets m proper condition For tranlporr by highway according to applicable InNerwicnal and notlonal government regulations. <br /> 4 If 1 am a large gvently generator• i certify Ilial I have a prep ram In place to reduce the volume and toxicity of waste generated to rhe degree I have determined Ia be economically <br /> pracricoble and that I kava Octet ed the rccricoble method oT trealmenr,storage,or dllpogal currently avoilable to me which mWmizea the present and future threat to human health <br /> and the environment;OR,if i am a small goannry generator,I have made a good Faiih OF—10 nimize my waste generation and/cleat rhe best waste management method that Is <br /> 0 <br /> available to me and that I can afford. <br /> y Prime Typed Name /� Signature Month Day ear <br /> U / '� <br /> Z ` <br /> W a <br /> A17.. tons ar r 1 kno ed em t of RWiti f o Materials <br /> W M Prim �, • Si oture r Month Day Year <br /> P <br /> — 0 1 B. Tr sorter 2 Acknawl visenr of Receipt of Materlals <br /> T Prin YPe d/7 d Name <br /> U-1 1 gnerury Month bay Year <br /> Sl <br /> Qh E <br /> V R <br /> 19. Discrepancy Indkorion Space <br /> z F <br /> — A <br /> C <br /> I <br /> 1 <br /> 1 20. FacilityC)wrier gr O arolor Certiflection of roceipi of hazardous materials covered by This monife,except as noted;n item 19 <br /> T Prinrvd/T ped Noma SI ncivre <br /> GD g M <br /> Y om- Day/ Year <br /> [/ rv} O V <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 9022A (1/991 ,. -sDiZ--.'-Cg HI;; ?•r'r, - <br /> EPA 8700-22 <br /> 7 ? . ? I Ci IJ trust n4.n .41 1 r, __.. <br />