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ite of Cali fornia•-Emironmentai Protection Agency <br /> i" OMB No.2050-0039(Expires 9.30-99) .. .S@@ Ins}rUCt10I1S OA E1f7Ck OfAQ@ b. <br /> se Form designed for use on elite(12-pt I tYPew P Department of Toxic Substances Ca+-s <br /> !' sotxanwtro,Colikrnio <br /> rUNIFORM HAZARDOUS 1. Gen ._.ors US EPA ID No. Manifest Document No. 2. Page I Information in the shaded area <br /> - is not required by Fedw 6w. <br /> WASTE MANIFEST C A L O O J 0 0 6 1 9' y l 2 2+ 6 A 1 t - a I <br /> 3. Generator's Name and Mailing AddressA• Slade Manifest Document Number <br /> RESD—BUILrING & PROPERTY, STATE OF CALIFORNIA .:.x2 0 0 8 7 5 9 9 <br /> 31 E. CHANNEL ST. <br /> Sr CC --'ON, CA 88202 B. Slott ID <br /> 1. Gen•ratoi s Phtt G <br /> one 1 948-7730 <br /> .q- <br /> 5.•,Transporter 1 Company Name 6. US EPA ID Number <br /> C Skate transporters ID lReserved.] y_ _ <br /> Sao?,HAZARDS SOLUTIONS, INC. C JA 1010r10 10161416141917 D. TransporttrsPlsase - <br /> xt a;►.,,.,,.,.,.:`800-746-7449 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E Skate Trainsporters 10 rReserved.1 <br /> (� u1/ 16131 2f 1114 F. Tromporsers Pharr <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Nmber G. State Focility's ID r <br /> POLLUTION CONTROL INDUSTRIES <br /> 54,35 TAY FOP. DRIVESST c oral l H. Focifity s Phan. — - <br /> MILLIDGMA# TSI 38053 ITND 10 10 10 17 17 12 111816 <br /> 12. Conroiners 13. Total IA. Unit <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. I Type Quantity Wt/Vol I. Waste Number <br /> —FRIDGF—RATION OIL,TRACES OF FREON sl°1i 221 = i <br /> G i 10:4—RGRA HAZARCOUS ..BASTE LIQUID0 0 D010101310 G EPA/06W <br /> N b --- <br /> E - star. <br /> =ti <br /> EPA/Othw <br /> A -- <br /> T <br /> C. state <br /> 0 f <br /> R EPA/Otfner <br /> di State <br /> EPA/01h•r <br /> •J. Additional Descriptions for Materials listed Above K. Handling Codes for Wastes Listed Above <br /> PROFILE #SHC4)1008 r?�.��" t b. - <br /> lJkcr.. - d _ r <br /> 15. S ial Handling Instructions and Additional Information AL 1 ��t-t L C�) ST��S <br /> A PROPRIt1TE PROTECTIVE CLOTHING Y' � 1 *. <br /> n FlIERGEI ICY CONTACT: (800) 74-0-7449" <br /> SEE E.R.G. PAG-" #171 f y;iiz ` CNo copix%i� .CP--°1Is <br /> E0A P E=4 CIA-&- - <br /> 16. GENERATOR's CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,pocked, <br /> marked,and labeled,and are in all respects in proper condition for transport kiy highway according to applicable international and national government regulations. <br /> If 1 am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economical <br /> practicable and that I have selected theracticable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human heoi <br /> and the environment;OR,if I am a small quantity generator,I have made a good faith•ffo to minimize my Waste generation and select the but waste management method that is <br /> availobl•to me and that I can afford. <br /> Print•d/Typed Name Signature Month Day Yeo r <br /> ear <br /> Q lY AVl G <br /> T 17. Transporter I AcknovAe4gisment of Receipt of Materials - <br /> r <br /> Printed/Typed Name Signature Month Day ear <br /> "s STZVE M YEIER l v YY <br /> P <br /> p 18. Transporter 2 Acknowledgement of Receipt of Materials l <br /> RPrinted/Typed NameQ Signature r Month Day Year <br /> RJ <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C �f <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this A-0 if6st except as noted i tem 19. <br /> T Printed/Typed Name Signature / Month Day Year <br /> Y I <br /> / DO NOT WRIT BELOW THIS LINE <br /> ! - DF cNC' uis -//GEN;:-A7, Q .vl*,_:.., <br /> 8022A 11/99) J"'-enera,c— _ cmrr razcrccu` ,.sre <br /> 8700-22 .ac av or �is - <br />