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State of$aMonuo—Enviren„e,d Pra,ec,,aa Agency t K r 4 kI VE❑ DEC 2 1 1995 <br /> Form Approved OMB No 2050-0089(kits 9-3494) . See Instructions on back of page b. Departmme of Toxic Subdtarces Contr. <br /> Pkose part a type Form despned for use on*&a(l2pfhfi) Souainento Cariferma <br /> +, =AD <br /> US EPA ID No Manifest Document No 2 Page 1 a rfo� he hadedl areas <br /> law <br /> . UNIFORM HAZARDOUSWASTE MANIFEST 9'181210101210141012 2 7 6 $ 1 of 1 s <br /> 3 Generator's Name and Marling Address <br /> sRT�c�s�Otrs F���yTratrs � �. .;` <br /> Imo. 494 S EL 00RA00. STO7CKTON, CA 4530€ •• IF7 �_;i"�- <br /> A Generator { <br /> m sPhor►e (303 ) 127-�5ti <br /> d 5,Transporter 1 Company Name b US EPA ED Number <br /> a7 Transporter 2 Company Nome 8 US EPA ID Number d <br /> 9 Designated Focrrdy Name and Site Address 10 US EPA 10 Number +9 ` <br /> ICc LA113LAW 9N`61ROSitEK*AL yER9€LES <br /> 8 :1' A Z D 0 4 9 3 1 8 0 101 'W'Pt,9 <br /> V 11 US DOT Description(includ ng Proper Shipping Nome,Hazard Gss aand ID Number) 12 Cordainen 13 Total 14. Unit <br /> Z No Quantity %" of <br /> H°Y-4CRA Hf '.ARVOUS WASTE, SOLID, f S0€s Cllr"irfGSjOl� E�. <br /> 1 E D1 j DI H 71 %00 P <br /> So N b x <br /> E <br /> R -�; <br /> A <br /> T <br /> O <br /> R <br /> to <br /> Z d s <br /> w R` <br /> V <br /> W <br />� T <br />� q <br />..d <br /> Z 1 S Spacial Handling lnshuehorn and Ad III, A hlformalron <br />� VBt7R iP?ROPRIAT6 PQ4"EC*?18 CLOTHING idffEV qAYULiRs g3783IAL <br /> 9RG# A)VA <br /> Z <br /> LU herinu Contact- intotrac 11-840-535-5051 15€5t <br /> Aeorcvais a PISR10001 b c, d <br /> 16 GENERATOR'S CERTIFICATION E hereby declare That the contents of the consignment are fully and occurately described above by proper shipping name and are cl*m ied, <br /> Q packed marked and labeled,and are in ail respech in proper canddan for transport by highway according to applicable federal,do and r„en aticnal laws <br /> V <br /> If I am a large qua"goverator 1 codify that I have a program 1n place to reduce the volume and toxicrty of wash generated to The degree I have determined to be <br /> economically praeheabie and that I have sslsdod the prachcoble method of treatment,storage or disposal currently available to me which mnmlzes Tia present and future <br /> threat to human health and the emrirorrrrent;OR, if I am a small quantity generator I have mode a good fadh effort to minimize my wosh generation and selod the best <br /> wash m method that a afford <br /> available to me and that I can aord <br /> 0 Pnnted/Typed Name Sgnohrre Morrh Day rYear <br /> -� A113 <br /> �C 0 <br /> T 17 T 1 A of Rech of Materials <br /> Z <br /> Pr,rde j"ped Month Day Yew <br /> � <br /> W s06Ka^z Ao,* <br /> X 0 18 Trani r 2 of eke, of Moi"Is <br /> LU it Predad/Typed Name SSR Month Day Yew <br /> U. <br /> O e <br /> • <br /> tX 19 Discrepancy lndication Spoce <br /> Q P <br /> V A <br /> Z C <br /> 1 <br /> L lay Owner at CArlifioolion of recowt of hazardous bv this momfed excim#as 22!!dIs lide n Item 19 <br /> /Typed Nacos ro� Mari V "l <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br /> OTSC 8022A (7/92) (Generators who submit hazardous waste for transport out-of-state <br /> EPA 0700-22 produce completed copy of this copy and send 10 DTSC wrthm 30 days.) <br />