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State of COPternia—En-lrenmanral Vretecrton Agency <br /> Form Approved OMB No.2050-0039(Explres 9-30-99) See Instructions on bock of pa 8 6. Department of Toxic Substances Conrr <br /> Plaose print or type. Form designed for use on elite(l2-plreh)ypawr;t•r. �Z,�41 ZL $af of To tic Subscallftances <br /> UNIFORM HAZARDOUS 1• Generaror's US EPA ID No. M00811 Doevment No. 2. Page I Infermwfon fn rhe shaded oreal <br /> / is not required by Federal lw. <br /> WASTE MANIFEST � � 3 � I fl` I !ci � � of a� <br /> 3. Generotor•s Name and Mailing Address T 6 m� {(C�{ yfl)ynjl'1+ 1ft'r t r11lE"!:'1 <br /> A <br /> �[, <br /> �1 r(L 4 rL�UJ� P/� <br /> un C) 1 s eona n. .4 CT•� �1 Cr NZ <br /> kc) d' Gnaroror's Pfi ?I� 1oT P 'L.uN1� <br /> 5. Troj r�a C any me 6. US EPA ID Number <br /> co <br /> Q D,9182030 11 7 <br /> 7. Transporter 2 Company Name 8. U5 EPA ID Number <br /> 9. Deslgnared Facility Noma and Site Addren 10, US EPA ID Number <br /> Co d ECO COY CONTROL INDUSTRIES <br /> a) 2M PARR BLVD <br /> RICHMOND, CA 84801 C A I D 01 0j 9A 6 16 319t <br /> P^'1 Q 1 1 US DOT Deserlpllon lincluding Proper Shipping Noma,hazard Clots,and ID Numbers 12. Containers 13. Tonal 14. Unit <br /> J No. Tye Quonrity Wt/Vol <br /> WASTE EMPTY STORAGE TANK <br /> G Non-'RCRA hazardous Waste solid j TP P <br /> o N 6. <br /> 53 E <br /> R <br /> Q A <br /> T <br /> � R 1 <br /> °` d. <br /> w <br /> V <br /> W <br /> Z <br /> Q <br /> 0. <br /> N <br /> 43 <br /> yCr <br /> Q <br /> Z I Special Handling Instrucrlom and Acs fltlonaln m ,ion <br /> Wear appropriate protective ci=ring whon handlin SITE LOCATION: <br /> Z 24 Hour Emergency Telephone Number: <br /> = 24 Hour Emergency Contact' L^�� ERGS! 191 <br /> 16. GINERATOR'S CERTIFICATION: I hereby dac ars that the contents of this consignment are fully and accurately described above by proper Ihipp Ing name and are classi Fied,pocked, <br /> marked,and labeled,and are In all respects In proper condition for transport by highwoy according to applicable irrernallonal and national governmam regulations. <br /> d IF I am a large quontlly generator,I certify that I have a pregrem In place to reduce he volume and roxiciry of waste ganerowd to the degree I have determined to be economltollyy <br /> N practicable and,hal I hove selected the Proctica6le method of lreoimeni,storage,or disposal currently avallable?a me which minimizes rho present and furure throat to human health <br /> and the environment;OR,if I am a small quanr'ry generator,I In"a made a good Faifh effort to minimize my waste generation and select the beat waste management method that Is <br /> 0 available Its me and than I can afford. <br /> Printed/ ed Name Slgnaru Month Day Year <br /> z G'I-L� a C .(,� D 6 117 1 <br /> 3 p 17. Transporter 1 Acknow)ed ement of Recei t of Materials <br /> 0-1A Prinred/? pad Name / Sfgnoture Month Day Year <br /> w D i B. trans otter Acknowled emenr of ecei r of Marerlalt r <br /> � 9 <br /> w Printed/Typed Noma Signature Month Day Year <br /> I <br /> V) RE <br /> -1--- I i I I 1 1 <br /> 6 19. Discrepancy Indication Space <br /> Z F <br /> — A <br /> C <br /> I <br /> L 1 <br /> I 20. FaclVty Owner or Operator Ce tiFcation of receipt of hazardous materials Lover this manifast except ted In Item 19. <br /> 7Print f yped Name Signal v! t ! r Month Doy Yap' <br /> Y ��� Lt, �- J tl r; <br /> Cf <br /> DO NOT RTE/BELOW A. !5 L E. <br /> DTSC 8022A 11/99) .v'irYs1 75W: SVIDS 'i HIS w•PY 'w :�T�,�.t•Y'T:-!i f :!!; �1•..'fS. <br /> EPA 9700-22 :cicrctmonia. $'. <br /> l,l cenn_�+ c cn, lilJ4, r rr 1 n 1 . 0nu <br />