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4l State of Colifornio—Environmenlul Proles lion Agency - - <br /> Form.App.roveu CMB No.2050-0039[Expires 9-30-99t See Instructions on back of page E1. <br /> • p 9 " D=parlment of Toxic Su6eionces Con IT, <br /> Irlease point or type- Form designed for ase on elite.[12-pilc6J typewrites Sacrnmenlo,Coli[—pi. <br /> UNIFORM HAZARDOUS 1• Generator's US EPA ID No, !.Manifest Doeemonl No. 2. Page i Information in Ike shaded areas <br /> WASTE MANIFEST <br /> aF <br /> is nol required 6y Federal low, <br /> 3, Generorer's Npme and Moiling Addres y# a fiz <br /> A:"Sik M'oailest pocdmenl Num6ei. <br /> f o T'eewy ce2 � ' B 51die Generdlor'i ID <br /> j - ^ d_ Generolor's Phone 62 <br /> i , <br /> C4 5, Trrcm5Aortvr)Company Nome r�°�l�1t�s d. US EPA ID Numbe <br /> tir _ C Stofa T pntpoFler't.14[Bess ed]_- -- <br /> Fi'UVBX'i ISSr� a� IT,fi:,. ;, 15 �L'aC.4• t D Tr'anFp0*!!'Phone �I <br /> -!.- 7, Transporter 2 Company Name - - 8, US ERA ID Number ;;'..State lfmndporier s ID[Reserve <br /> 4 V.lrcnsporter`t Phone <br /> Ej 9. Designated Fadli Nome and Silo Addreks <br /> g h 10. USEPAID Number 3i.'Slate Facility's fb _ - <br /> a'Z 2OW N(I'M AI_ DA STREET <br /> a H F'I- s Phono <br /> O_ WiON CA 9= <br /> d V12. Containers 13. T.Icl i4. Unit <br /> t 1 US DOT OT Descriplion finclodfng Proper Skipping Name,Hazard Class,end ID Number) <br /> No. Type Ouonlily wl/Vol F !Hosie Numhof <br /> Z .r. SIple <br /> ( f 1 <br /> -"V9t6 <br /> -3 o N 6• <br /> m E <br /> -q : R TEPAeq <br /> /btl or { <br /> I _ O T r <br /> co 0 <br /> R EPA/01hI Lu <br /> l <br /> ;1 W d. slat. <br /> �w 1 <br /> U EP A7olher <br /> w ` <br /> ' Atlrliliptsal 4eser pKara lqp lylal6r aip 1Jslrtd A,6aol K Hundbng God@n far Wastes Listed Ab <br /> ovs <br /> uj <br /> 4. <br /> r d <br /> �0 15.Eecial Handling Insrructlnm and Addlllonal Information . <br /> ,I Q EWRGENCY I,iL I AG r,CiHEMTf EC t: }4'214�X ) <br /> I <br /> _1-Z 16, GEkFRAYOR'S.CERTCFlCATION: I hereby,declare that the cuntents of Ihis.consi nmen[are Fully and accucululyy descrihed above by proper shipping Home and are clmsified,packed; <br /> Vmarked,and.labeled,and ore in all respocts Ir proper condition for transport by highway according to applicable international and notlouol gavemmenl regulalions. 1 <br /> �-e If i am a large quantity gengrolor, I cerli Fy Ikal I have a proyrom in place to reduce 16e volume and toxicity of waste generated to she degree I have dererrhined to 6e economically I <br /> .J� practicable and Ihol 1 hove selected the praclicd6fe.method aF 48otmenl,stnroge,or disposal currently available to me which minimizes the present and future Ihreb{to kuman heaR <br /> r 1 a, and the environment;OR,if I am a small quantity generalor,I have mode a good faith effort to,minimize my waste generation and select The best wosle management mefhad thol is- <br /> Q avoiluble to me and]marl can aFl.rd. f <br /> Signature..,^!.', :.Month _ -Days Year <br /> "I <br /> RT V. Tronsporler l Acknowled emenl of Recol 1.o[Moteriuls <br /> .rJW A8.-- Priiiled/Typqed_-Name - 1- t Signature ),,-] 1._1. ... ._ Month Day <br /> Ps1 V,.Rei -�I <br /> 18. Tram orler 2 Acknowled emenlof cei t of Maloria6 <br /> ] R - F'wed/T ed Nome fvs, <br /> r [j� E yP - _ - Signature Y� Month Day Yew <br /> LU tis R. <br /> _-V 19, Discrepancy Incilcatton Space - <br /> =;I , F <br /> A <br /> C <br /> E <br /> 3 f 20: Focili Owner or O .rotor CarliFicalion of reset I of hazardous materials covered 6 this manlfesl except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Your- <br /> ...I -Y <br /> DO NOT WRITE BELOW THIS LINE, <br /> DISC 80224(11991 <br /> EFA 8700--22 Ynllow: GENERATOR RETAINS <br /> 1. 1 <br /> I <br />