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State of Agency <br /> Form Appr;vsd OMB No 7050-0039(Expires 9-30-991 S" Instructions on back of pab b. Department of Toxic Substances Corm <br /> al•are p—,or type. Farm designed far use on elite(I2•p)reb)typewriter IPI N, Sacramento,California <br /> UNIFORM HAZARDOUS I Generator's US EPA ID No // Manifest Document No. 2 Fogs I rformation n the shaded armor <br /> WASTE MANIFEST L 3 7 b �l �' of 1 °not required by Fed•ra'.law. <br /> 3 Csenerotor's.Name and Mailing Address <br /> A rcbIn <br /> A Generoto's Phone 1'7 , h L' rot et q l*i <br /> n <br /> CN 5. Trace 6{Cq)IspanY�Ip�P 6. US EPA 10 Number }_' <br /> 0 <br /> D98203101 7 <br /> 7 Transporter 2 Company Name !. US EPA ID Number <br /> 9 Designated Fo6ll Name and Site Address '.0 US FIA ID Number <br /> g ECOLOGY CONTROL INDUSTRIES <br /> ,T 235 PARR BLVD <br /> am <br /> cc o RICHMOND, CA 9Mi A 0 0 9 4 6 6 3 9 2 <br /> r-' Q 12 Cortoiners 13. Total 11. Unit <br /> 11 U9 OOT Descnpt(on(including Proper Shipping Nome,Hamrd Class,and ID Number) Ne. T • Quonr; Wr/Vot <br /> WASTE EMPTY STORAGE TANK <br /> 3: E Non-RCRA hazardous waste solid100j T P <br /> o N b. <br /> coo E <br /> N R <br /> v A e <br /> T <br /> ao O <br /> R f <br /> w d. <br /> Li <br /> LU <br /> U <br /> LU <br /> N <br /> Z <br /> 2 <br /> iA <br /> W <br /> Ce <br /> a <br /> 13, Special Handling tmtruefions and Addit anal niq�m¢tion <br /> Wear appropriate protective Cng when handlln SITE LOCATION: <br /> 24 Hour Emergency Telephone Number: k / e / jvri r <br /> 24 Hour Emergency ContactsL? ��� ERGS 171 <br /> -J_+ 16. GENERATOR'S CERTIFICATION: I hereby dee are that me contents of this eensignmenr are fully and accurately d.-6.d above by proper ship Ing nom•and are ciiami{red,packed. <br /> gmarked,and labeled,and are in all respect&In proper eendlfle i For transport 6y h ghwoy acco•dsng to applicable Internailonal and nmional government reguiorons. <br /> If 1 am a large quantity goneroror,I uMify that I have a program in plote w rediae the volume and laxielty of waste generated to the degree I have determined to be economically <br /> practicable and that have selected 16e practicable m.,had or treatment,storage,or disposal currently avoi;abie to me which minimises the prowl and future threat to human t eolth <br /> and the envlranmerr OR.:f I am a smaquantlty generator,i-ave made a goad 6fh effort to rnm.mise my waste generation and ssiect the best.va,fo management method that is <br /> ac —1.61.m me and that I can afford. <br /> O <br /> Prmtad/TxAod Name Signafu Month Day year <br /> z Lg tri.L fh c <br /> 016117 ! <br /> w T 17. Transporne,1 Acknawied ement of Receipt of Morertals <br /> � R <br /> w s Prmred/typed No" Srgnotura "r Month Day Yea' <br /> iC-,� I zI l y <br /> r g !8 <br /> Trar.p2rfor 7 Acknawl•d amens of eit of Materials <br /> 0` T 1—tod/Typed Name S gnatur• Month pay Year <br /> ui <br /> res A ! � <br /> U19. Dllcespa,cy ird;cahon Space <br /> Z A <br /> C <br /> I <br /> ` f n <br /> 1 20. Fos ry Owner or Operator Ce rite orlon ofreceipt of hazardous materlols covortox this;am!;,, 4tad In Item 19 <br /> T P'. /yped Name Signor i / Manch Day Tear <br /> YJ� C h �� <br /> ry Ll <br /> DO NOT, TE BELOW tS LA' <br /> ¢ <br /> DTSC MMA (1/991 I „),ick: 'SD ;E: DS 'HIS LOP" "C• WOSC WJ-1r! <br /> EPA 870C-22 <br /> 6 ' d b6LPON 6000-£ti6 60Z WdlS 6 6661 8l Q�d <br />