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3. Generator's Name and Address Mailing r A. State Manifest.Document Number <br /> 931828211 <br /> Z LL 1' fA,It OnIV: <br /> 5 -0( C�nerator's ID <br /> KTOIJ C /# r 20_ B <br /> C14In 4. Generator's Phone ( ) 2 0 9 �to(1- ��2 Z�( 114 fr N V M 6CQ4f p Q 5'1 <br /> 00 5. Transporter 1 Company Name 6. US EPA ID Number C State T amporter s ID,, 2/ ' <br /> (p 'r <br /> 00 "D. Transporters Phone- <br /> Eri ,n C �t <br /> 7. Transporter 2 Company Name S. US EPA ID Number eai$tote Transporters ID L� <br /> Transporters Phone' j-y Y s <br /> Q 9. Designated Facility Name and Site Address 10. US EPA ID Number Gi`State Facility's ID '• { $ A <br /> A L 134 SJTR C5-r „Fc ,lity's Phone <br /> U <br /> 12. Containers 13. total 14. Unit <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> Z No. Type Quantity Wt Vol i <br /> 0. <br /> Q 4 t,+Q•DoUs ,45TE L/0011) "'O' S. <br /> 3 6sT' �4 <br /> C� E <br /> 0i M E Nq 9 l C Ko G Z) T o G- <br /> SWPC `P <br /> p T C. <br /> 0 APR 2 9 1997LU <br /> d_ 1 Stag <br /> Z Sl'OCK (1PJ,CA <br /> iJ MAIL tee �.-- <br /> w <br /> U0 <br /> 2 K; Handling Cod'ti b6 WasieS Listed Abovp� <br /> Q I�..•' i <br /> N a. ( 6, <br /> ii_!h a y�' - t <br /> LU t fa+ <br /> LU <br /> Q <br /> 0 15. Special Handling Instructions and Additional Information t - <br /> LAS6 PQO CIC PROTELZIvE �QuJPM>r� jdt4-e-J f AN��Jni�. (,OS!!A LEv6L G , <br /> LU <br /> ERICk5a�1 I uC., (gvo) 35-&—03/3 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contenh of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> -' <br /> packed,marked,and labeled,and are in all respects in proper condition for transport b highway according to applicable federal,state and international laws. <br /> Q P P� P Pe sPo Y 9 aY 9 PP <br /> V <br /> If I 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 <br /> economically practicable and that I have selected the practicable method of treent,storage, or disposal currently available to me which minimizes the present and future <br /> threat to human health and the environment;OR, if I am a small quantity gene, or, I have made a good faith effort to minimize my waste generation and select the best <br /> waste mono <br /> gement method that is available to me and that I can afford. <br /> O Printe /Typed Name Sign Month Day Year <br /> NU12 - 0 <br /> Z T 17. Trans iter 1 Acknowledgement of Receipt of Materials <br /> W E <br /> NPrinted/Typed Name Signatur Month Day Year <br /> s <br /> W p <br /> o 18. Tronsportee'2 Atknowled e6enf of REcei t of Materials <br /> w R Printed/Typed Name■ Signature Month Day Year <br /> 6L. E <br /> 0 <br /> W <br /> lo �c. G4ccoNs = 317 �lvT 3 90o C� <br /> Z ` 4 CN-+C. 6 5T/M4TU; <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. !' <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> 7/92)( <br /> t7TSC 8022A (Generators who submit hazardous waste for transport out-of-state, <br /> EPA 67022A produce completed copy of this copy and send to DTSC within 30 days.) <br />