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�taN a1 LC,ilIO/M1ra—Cnv,ranrnWr,Yl r,Y�•�iiui�+y y <br /> Form ApernWd OMB,rIo 2050-0039 IExpin•9-30.991 See Instructions on back of pt�004.�f Department of Toxic Substances Control <br /> P!.y,e print or type. form de,grid lar uw an sfUs 112•pbehl typewrltsr. !� s. s Sacramento,California <br /> 1 Generator's US EPA ID No, Manifest Document No. 2. Pogo I Informatlon in the shaded areas <br /> UNIFORM HAZARDOUS ,net required 6y Fea.ral low <br /> WASTE MANIFEST if .3 <br /> of 1 <br /> 3 G•n•rofor't Nam•and Moiling Addra + <br /> In <br /> f 4 Generator's Phone 17/1) 1 G 10 1 '.)Z— La pci:'('IACv�v �'.2 C('U �,/-• <br /> h S. Tramp r,3 !�Nam r4 A s� / %A II& <br /> a* A <br /> P <br /> 7 T(ansporior 1 Company Nems 6. US EPA ID Number <br /> S �CU�C7oY`Gi�N��Liil����?RIE$ to US EPA ID Number <br /> 7)z� 265 PARR BLVD <br /> .Uo RICHMOND- CA %W1 IAI 41616131912 <br /> 12. Containers 13, Total 14 Unit <br /> 11 US DOT De ripilon(including Proper Shipping Name,Hazard Class,and 10 Number) No T • Quantl Wm/vol <br /> WASTE EMPTY STORAGE TANK <br /> 3 a 'Non-RCRA hazardous waste solid T o P <br /> E <br /> o N b. <br /> eine E <br /> R <br /> v A <br /> 0o T <br /> m O <br /> - R <br /> LU d <br /> w <br /> l.1 <br /> W <br /> Vf <br /> Z <br /> 2 <br /> Win <br /> OL <br /> Q <br /> 111fe "�itdt�L"��i"� 91i When handil SITE LOCATION; '3t 2 ry Cc/'�w��•�} <br /> Z 14 Hour Emergency Telephone Number:�ft �'Sd q - rfoc�f.►-c O,�¢ <br /> 24 Hour Emergency Come A ERCk# 171 <br /> 16 O[NERATOR'll anFiCAtION: I hereby declar.thai the content.of this consignment or&fully and accuratslr,d•.crlbad oboe■by prop.r chlppfng nam•and me dacufmd,Pocked, <br /> U marked,and labeled,and are to all respect+in proper condition for trorsport y highway according to app Coble internotionol andnottono government regviolions. <br /> = If 1 am o large quanlllgenerator,i comfy,that I have a proo�p ram in place to reduce PMA volume ord toxic.ty of-,3.W generated to the dg,-1 ham determined la bo• riomicoi{y <br /> N practicable and tkat I Kava.elected the p—f—bid method of tnormenr,slorape,or dspwai currently ovailoble to me which minimises the present and future threat to human health <br /> and the environment;0R,if I am a small quantily generator, hove made a geed faith effort to minimi,,my wase gensrcdon and.sl.t ih■6■.t wa,ro management method that u <br /> °C av i.6l.to m•and that I con afford. <br /> Q <br /> Printed/Typed piliams Signotur. Monih Day Year <br /> u' T 77 Transporter I yknowled einem of ecei t of Materials <br /> Printed/Typed Name Signator Mach Day Year <br /> w <br /> IJ o�I // s a 1611 7 19 9 <br /> 0 1A Transporter 2 Acknowled emam of sal t of Moterleis Joi <br /> 1 Pr'.rred/Typed Nome Signorure ti+onth Day Year <br /> w F <br /> R <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> G <br /> 1 <br /> L <br /> 1 20 P Ilii Owner or Operator Csrtifleatlon of reccol o hazardous materials cover4h this n.460 except iNnotod In It.m 19 <br /> T Prl /Typed Nam. Signa Mol <br /> y — Day Year <br /> y <br /> C <br /> DO NOT R E ELOW HIS <br /> t' wlo, 1wr SEMIS'R 115 copy IO WSC'APHNIN all DAY!, <br /> EPA 8700-24 <br /> DISC 0 (1i99f `r T(v P.O. 8- 3000, Sucrutnoni,i, (:A 9.581 <br /> , <br /> Oi ' d ti6tl �N 6506-£ti6-60Z Wd10�6 6661 81 ��d <br />