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Stat ofCulifomia—Environmental Protection Agecy - <br /> orrr�siApn <br /> proved$ d OMB No.2050-W39,(Expiras 9-30-96) See Instructions an.back of page ft. Department of Toxic Substances Control- <br /> Ple prim or type. Form designed for we on etete(12-pitch)typewriter. Sacramento,California . <br /> UNIFORM HAZARDOUS 6)i1p9ehli(631751 <br /> Generator's US EPA ID No. Manifest Document No: 2. Page 1 Information in the shaded areas <br /> is not required by Federal low. <br /> WASTE MANIFESTof <br /> 3. Generators Name and Mailing Address <br /> STOc. <-ToU VLIIFILu --ZNOOL b15T�.tiC.T <br /> 19 4-4 0. 5L P1 UA I, nC., � s`ra�c��-1, Cao 4 52 5 <br /> Go <br /> " <br /> I. Generator's Phone (IOR 953—4c)6 <br /> 9 5. Transporter 1 Company Name 6. US EPA ID Number <br /> 00 <br /> 7. Transporter 2 Company Name �8. US EPA ID Number <br /> V <br /> Z 9. Dy�jgn Cdt F`a�cility Ngrne and Site Address 10, US EPA ID Number . <br /> 2{ Y R OjL LITC. <br /> 0 255 Parr B1\4- <br /> '"�a Ric hmnd,CA 94801 CiAiDi0i0i9i4i61613191111 2 <br /> 11. US DOT Description mcludin Proper Shi m Name,Hazard Class,and ID Number 12. Containers 13. Total 14. Unit <br /> Ir� Z P ( gShipping I No. Type Quantity Wt/Vol <br /> = <br /> 'NON-RCP-4 HazaoJous Waste Solid <br /> N --r-10A G Waste ��tu Star q Tat k. �' �' � Q P <br /> WN b. <br /> 00 4 E <br /> C'4 R <br /> o A <br /> C. <br /> co <br /> 0 <br /> LU <br /> � R <br /> Z d. <br /> ru <br /> V <br /> - yet <br /> x r. <br /> uLI <br /> _ ex <br /> J <br /> _i <br /> 0 15. Special Handling Instructions and Additional Information <br /> P: Keee, away from Sc)urceis of j_gCfit.irri1. R���y: 4.k-ar hardttat.s T,�A1.et1 wAK) kil'1�7 arcAjnd <br /> Z U.G..S�'.T, E, 24 �. ("iRtll-,,-t Td�tff � � I � f'�tc�ti�,. .3 - L,n rJ T� <br /> LU <br /> C1g4A?L65 Lev$x/5k X,53- 4061 Df3 <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, <br /> ='r packed,marked,and labeled,and are in all respects in proper condition for transport by highway according'io applicable international and national government regulations. <br /> JIf 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 he <br /> d economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> Vt threat to human health and the environment;OR, if I am a small quantity generator,1 have made a good faith effort to minimize my waste generation and select the best <br /> _: tY waste management method that is available to me and that I can afford. <br /> 0Pri ped Name ;^ Signature` } Month Day Year <br /> Z T 17. T orter 1 Acknowledgement of Receipt of Materials v <br /> I (D IRl P / ped Na`mme f� F yc{y Sig re r } Month Day Year <br /> �'�; W 5 �.�4• ��� � l <br /> - P <br /> w 0 18. Trans oder 2 Acknowledgement of Receipt of Materials <br /> Lt. T Printed/Typed Nome Signature Month Day Year <br /> O E <br /> R <br /> N19. Discrepancy Indication Space <br /> Q <br /> V FA <br /> Z_ C <br /> 20. Facili Owner or Operator Certification of recei I of hazardous materials covered by this manifest except as noted in Item 19. <br /> l T Printed/Typed Name Signature Month Day Year <br /> Y <br /> I <br /> 1 <br /> DO NOT WRITE BELOW THIS LINE. <br /> .j DISC 8022A (1/95) - Yellow: GENERATOR RFTAIN5 <br /> _j EPA 870022 <br />