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. State of Colifornia--WE.-ullh and:.4'eltcre A�}anoV " .. ." '; , Department of Health I' R Apory✓edOM8No.2050-0039{&pir6s0-30-01) See Instructions on Lack of page E. toxicsubsrcncesConlrolFtc fc;m PleasE print or ype. Wm d©sirgned for use pn efile(12-piicn typewriter). Sacramento.Ctilit�: UNIFORM HAZARDOUS 1,Ger woiois LIS EPA ID Nof Manifest Document No.' 2,Pag. I� lnforrrrrtton in tri,shaded owcr, I WASTE MANIFEST • qAq 000I 6,70t. 00 � . 01309 '1 a noror aired n F l I I I of q Y oderpi law. ..�, 3.Gernrotors Naino urvJ?,1u:4n�'A,de.lr� G5. S!a!e IAaridosl Dceumonf f•Fumbar -77 -eARAN AVE---S-rO(,-ifTON-.-tA-.-VffMI A�F,�7r'sc41 A11'4, _ p , B state Gonermor s p i, 4.Gonerolofs Phono( i'J X12 r P Y�c ��/�' t*?*ro 1 6.I.1S EPA ID Number G Stab lrarnporta SIO h I I I I I I I f i I f Trorisport©rs Phone .. L 3 7.Trans pprter 2 Company Pictrnb 8,US EPA 1D Number £ S1oleTransportorslD I 1 I 1 1 I I I 1 ! 1 F Trans 0ods Pose 4.Designated FociFfy Name aril Site Addross 10.US EPA ID Number JJ PRC 1835 EAST 29TH STREET G stateF ..0'1 ....I r 1 I 1 1 I r t I # 11 cly SIGNAL HILL, CA. 90806 CAT 080011059 H F-,7niysPhorx 213 ::595 7:431 I I f I I 1 I I I A i1,tSDOT 12 Containers 15 Total 14 Unit Ooscriplbn(including RoparShipping Nome,Hazard Class,and ID Number) " J a No. Type Qanlly VAfVol 1..1Yosio Ntirlltet: t 1 v G sfrfe223 Q E NON RCRA HAZARDOUS WASTE SOLIDS 0 0 1 D M 5 5 G hPr Z N b I I I I t I 0 O E srne R F Q A Z T c ! I I t ! ! I ....-,!� O Stag R CO � 1 'V � he( a 1 I 1 I I 1 F Addrtarb!D6scrspiiorn For Afofennh TlstedAbove rxl!mg Cosies 10.JJasles.Ustetl Above c .>: 15,Special Handling Instructions and Additbrspl information s, 24 HR. EMERGENCY CONTACT; 1-800-874-4444 0 24 HR. EMERGENCY RESPONSE: CHEM TEL INC. 1-800--255--3924 APPROPRIATE PROTECTIVE CLOTHING & RESPIRATORLu ; c ZJ -41 16. GENERATORS CERTIFICATION; I hereby declare that the contents of this consignment are fully and accurately described abovo by proper shipping name and are clossif ed. 0 packed,marked,and labeled,and are in alt respects in proper condition for transport by highway according to oppl'cable iniemationar aryl net anal govomment regvlaf!ons. ' QIf I am o Surge quantity generator.t certify that I here a progrom in Place to reduce the volume and toxicify of waste garwafed to the degree I have determined to be z economically procticobfe and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future u, threat 10 human heo4h and the environment:OR,91 am a small quantity generator,I hove mode a good forth effort to minimize my waste goneratbn and select the best Fs management method that 6 wnft' ailobie to me and that I can ocd. waste J Printed/TypelName Cf /7// ' U -IVSl'' "(� `'� r /rcS�GRfF Spa e Month pay rear 01 v7 Tg(/7- 1 17,Troinporter 1 AcknowSe "/ sl dgernent o1 Ras ' t of Molerk* ' O R Printed me S NMonth Day year LU z S A C0 P f 1 C.. 1 � V1 / IL p Trans Acknowle ement f ftecei t of Materials 'w R Printadf, IVarrse Signature Month Clayin E y ra u I 0R toF 19.Discrepancy ksdicotion Space 1� A I L 20.Facility Omer or Operator Certification of receipt of hazardous male6als covered by this manifest except as noted in ifem-%D — Printed/Typed Name Signature Man:h i I I DO NOT WRITE BELOW THIS LINE. DHS 8022A(12/9o) 1Ntute: TSDE SENDS THIS COPY TO DHS WITHIN 30 DAYS, EPA 8700--22 To: P.O.Box.',COO,Sacramento,CA 45812