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l <br /> j Stale of Col'rfornio—Environmental Protection Agency <br />` `arm Approved OMB No.2050-0079(Expires 9.30.99) See Instructions on back of page 6. Deportment of Toxic Substance's Control <br /> lease print or type. Form designed for we on elite I'12-pitch)p writer. i`' Sacramento,California <br /> _Lnerator's US EPA ID No- Manifest Document 2. Page 1 Information in the shaded areas' t <br /> UNIFORM HAZARDOUS �- *- is not required by Federal law. <br /> WASTE MANIFE5T , + / br. of:• t <br /> 3. Generator's Nome and Mailing Addresse-� i5taiahlnmfastOoeumattl luillbit, <br /> B-staroGaneralodslD <br /> O 4. Generator's Phon ) �- ��� T yl Ct 1.�tr r " ' <br /> 5. Transporter I Company Name 6. US EPA ID Number C•"STQIeL 7 <br /> Transparteti ID a <br /> p ,r- • . -.s �. ._, .< -��. - - D '.7rantparfdes Pftona <br /> j /A .y�4-i:1 �:�1t'r V F�L.L.L r r r.1-.r L ..J b. -i v, i. ,. - •,:.r �,t{-.t /�/AV !-> �►c/ <br /> 1) 7. Transporter 2 Company Name !8.rUS EPA ID Number E�,Iwo Transporrors 1pt;,f• <br /> Nr r <br /> k F. 71nnspoth s Pham 1 <br /> U 9. Designated Facility Name and Site Address 10. US EPA ID Number G:^State Faa•ls ID r a --,? <br /> IalJl!` I fi#ilL. :ifv.t{s/!f,.i; <br /> Oft <br /> � p � � � � 4 b •� r U l�� �. <br /> )� S 711f, `i 0-r C] G f ii a rf}i( tone <br /> 110 Lrt, x.15 .J lJVCJ V. i/ L' : :J <br /> r �F l2. Containers 13. Total 14. Unit I <br /> 11. US DOT Description{including Proper Shipping Name,Hazard Class,and ID Numbed <br /> )� r No. Type Ouonlity wi/Val I. Waste Number] <br /> a t .• IrJ! } Stale i <br /> } G , EPA/Other i.. <br /> y E e . <br /> t N b. State <br /> co E <br /> co E EPA/Other {� <br /> c. <br /> T 5rate <br /> co 0 <br /> R EPA/Other <br /> a <br /> Ld. State <br /> {' v' EPA/Other <br /> W <br /> JAddlhonaf t U lid Abore i' `g" ;, k e e K ;Handling CAd+s far 1Nastas L}ted Above j <br /> b;�w <br /> S �.�D£ - <br /> ,^ <br /> { w �', r f•,y�;" ,y. ah Ss=y,E' '$,..-1 v n :y sx; R ,,„•s, ta ,s _-s s' 't4z�r 1 x � n'"y"�a r a r r n' i <br /> y +`�a-.• 4 ���3r �a aY;� a�f �'s ",ti� s moi.hr �-'�. 1 r Tr t <br /> 15. Special Hondking Insiructions and%Additlonal Information <br /> i'rl� vt y ( ea lOe <br /> Z is MCRC ENCY 1.44 P%4F <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,packed, <br /> Q marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> I V `` <br /> LIf I am a large quantity generator,I certify that I have a program in place to reduce the volume and taxicily of waste generated to the degree I hove determined to be economicallyy 1 <br /> practicable and that I hove selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human he: <br /> and the environment-OR,if I am a small quantity generator,I hove made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> available to me and lhnt I can afford. <br /> Printed/Typed Nome •t_;>~•Y. r1- Si no! re� u { <br /> { 5 g y Month Day ea <br /> „•. ,,;;I#I, L .T�At ` UAA <br /> L (A— <br /> T 17. Transporter 1 Acknowledgement of Receipt of Mater' is i <br /> p <br /> ,t Printed/Typed NameI J; Signature Month Day 'Year <br /> ____ fi=t <br /> P / <br /> 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> R Printed/T ed Name Signature T YP g Montt+ Day ::Yea <br /> Lw E <br /> R <br /> F <br /> 19. Discrepancylndicaliop Space <br /> A i <br /> € C <br /> l l <br /> L <br /> 120. Faciii Ownerwr O rotor Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> } Prinled/Typed.Nansoir Signature Month Day, 'Year <br /> ! i <br /> DO NOT WRITE BELOW THIS LINE. <br /> SC 0 (4/97) Yeilo . <br /> A a7o0—a-22 - <br /> I 'I <br />