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------------------ <br /> Slate of CfSiiforftia—Hedfh and Welfare Agency -� Deportment of Health S•evc <br /> See Inshruclions on l p[pogo 6, To Deportment <br /> Substances Conhd Progrc <br /> Plaose prim dr type. Foes duso—of for Las on•rte eh typewriderl socran,.nto.CdNor <br /> UNIFORM HAZARDOUS1.Goneralors LS EPA ID No. Monlfd sl Doewront No. 2.Page 1 Information h the ssroded once- <br /> WASTE MANIFEST IQ I I l4 6(Ol/! l Z 0010 ,oil I/of I-not-QL"d by F.dord taw. <br /> 3� Adam p40 i&Spar.Mantes!Doclrrtmrd"bet - F <br /> 4 G.rardors Peon.(2.07) s23-&-1& <br /> 5.Tr Or 1 Com <br /> P¢rY►'lama d.L15EPA,IDNurtrber �.�+ CrSlalaitanportofs�.:: ;< - <br /> FIYD+LU-CtJ,SA/I S+G,411QFtj MK. GArOt Q18i� Ilt'yl r W.TronsportKs_Phan. <br /> 7:Tranporlor 2 Com E:Stat.7iansporfats ID;:;. <br /> PaN � B.tS EPA ID Number <br /> - I 1 ! I t f 1 1 I 1 f FTmre ersPhpna _ _ <br /> 9.Des;gmted Focillya Site Address 10.Lb EPA ID Number Slglefoclltyt tQ r f cti <br /> Ie4y��.�Ci �QaJrC46 <br /> + <br /> rra�3a.;J CA- 933o l Cu41Qr� 31/ 161617 "j `Pi+ ' 'g2D* <br /> 1 T.U6 DOT Deserlptlon(Inkling PnnmrSh"r12_Conrovmm 13,Told 14 and <br /> pping None,Flksr[stl Clan.and ID Number) No. T Oumnt MfvoI ' W <br /> .: <br /> ctLcm NA s w�4T�,tZ. a r` ooT- E-7'41 L 42o r� rl 001 r i r , <br /> Cn o E <br /> •y= O � — Slake fi <br /> N RCP <br /> m d <br /> N _ { <br /> 4 - <br /> J.�Attclibrld <br /> MalarnM feted Above t <br /> h'Ip[rCAll'Igcodes r«wasles fated Above -s <br /> uj <br /> ..... .:...:--:. .. r...... :.:..:... s <br /> fir,., 15.Specht Flandrrnp irVlrtrdiorn and Adtlitiorxy Informotron <br /> i1 <br /> Z4 v4 a. > m L« CT = $off - 8� <br /> Qfn <br /> Lu <br /> J ' <br /> Z I& GENEMIQiM'"qF-M 14ZQnON:r_hweby declare that.lhe,canhnfs'of th4 cmiprxt»rd ars 0*vrdscfb <br /> racckmpl�tjr deed adore iay.Proper slYppinp rs>rn•and an clmsfisd <br /> O pocked,marked.and labeled.and ora In al imspaets'in�pr' r e6n6ti ri rorfrar.port by highWoy aok:ooM to oppieab inrernatfond and.ttatiorror pwarsrt•rd ropfialtoere <br /> Q F1 am a bF9G vu0nt#V generotor,I codify that I have a program in place to reduce the vokme and toxicity of wade generated to ftre degree t have determined to be <br /> Z acanomicaly proetkvble and mai r have,elected the pR]ctir-�ble method of troatment.dotage,or disposer aurentiv available to me which min n izes to present and rutki. <br /> 2 thaot to hm" heath and the en4orment.OR.F I om a Anal Q"ftgenerata.I have mode a good folth effort to tzrimae mywcsts generation and select the best wrote <br /> r~ mangerrrent method that is avoiable to me and that I can afford <br /> - J <br /> U Prinled/Typedd Norne�+y Y �/f� Sipnafue _ <br /> 6,7t �1 iJ 11'f 1_.�' - '�I -l- 'W. - N'L :y'-Y Y.�i :/•���,,�� {ori - �tOrthl Year <br /> .,a 'a.r, ,'_.._:..�.: x- :�► �• - ."'Z 4 ,- sl ,4-` r� ,arm-�: � (w�,.- rT�,�ery�=_ _ <br /> C T 17.Transporter 1 Acknowledgement of Rece"or matend, <br /> R Prned/Typed Name — signature Month aeyYear <br /> U N ``�+ - s_ <br /> z S rG�j -'-rti. . Y. .._ �.�t4_`'i�:R�*Y,�` <br /> Luo 6 f, 2t r:njq, <br /> O 1 B.Tram 2 AcMnowle emen of Receipt of Mot <br /> � R 1PAnled/TaypedlMme Signature -66Y <br /> u, T trtarm 666 Yat! <br /> VL <br /> O E -R <br /> - <br /> Lu <br /> U19.Dscr•F pa,cy Indication spots <br /> z A <br /> C -- <br /> L <br /> I 20,Focilty Owner or Operator Certification of receipt at hozardora materia6 covered by this manifest except m noted in Mem 19. <br /> T I Printed/Typed Name signaft" <br /> Monts t]4Y Yea <br /> r l r l r <br /> DO NOT WRITE BELOW THIS UNE. <br /> DHS 8=A(12190) Blue: GENERATOR SENDS THIS COPY TO DHS VATHIN 30 DAYS. <br /> EPA 6700-23 To: P.O.Box 400.Socrumento,CA 95912.0-M <br />