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3. Generator'sNo.. n Mailing Address to M ,fest Gccv s w 'er <br /> O 1 MZW4A) IAl/1E(� pkotkUc7S -4.0r2l"0174 o 931828.21 <br /> nT VC i<T&tJ C A • tt 5 2Q /fir 629 <br /> G^e eje�rator's ID <br /> h 4. Generators Phone ( ) ( z a 9) 7`l1- 0p I C J� 1-I r_ A)V NI•Js-•l �t/ <br /> <br /> �S 5. TronsporMr 1 Company Nam 6. US EPA ID Number C. State Tra;nporfer'sa2 � <br /> ae CA <br /> To C trho ®, <br /> r <br /> b <br /> 7. Transporter 2 Company Name 8. US EPA ID Number xIO <br /> 144U <br /> W Z 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> N� RoLLIMS Or Pr C. <br /> Do= s7sc, Reda $TRe6T- <br /> :HM A#6Les 24. 9po5tr idi R o <br /> 1•! 11. US DOT Description(including.Proper Shipping Name,Hazard Class,and ID Number) NComairrers 13. Total 14. Un' <br /> ... No <br /> . T OuantilY Wt/Val <br /> Q Aj;4R'Ddu5 AsTe Nxo, S• 1. <br /> NA 918 90 ") ssr a G <br /> b. <br /> � r r�SWPC <br /> A <br /> � r < <br /> R APR 2 9 1997 <br /> W <br /> d. <br /> Z <br /> v OUR <br /> MAU <br /> W �.. <br /> 2 <br /> O <br /> a. <br /> N <br /> W <br /> C <br /> J <br /> Z <br /> Z <br /> Q 15, Special Handling Inshuctons and Addltbrwl Information <br /> a t45ts PQoPER eXOTecrlvrr Cove?HGF 046 f ANd LlAP4 (.050A LEv6t_ " C ` ) <br /> EAI4k56J <br /> J 16. GENERATOR'S CERTIFICATION: I hereby declare that Ite'contenh of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> Q pocked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international laws. <br /> U <br /> If I am a large quo"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 be <br /> d economically practicable and that I have selected the practicable method of fire ,storage,or disposal currently available to me which minimizes the present and future <br /> ythreat ne human health and the environments OR, t 1 om a small quantity genetor, I have made a good fait: effort to minimize my warn generation and select the best <br /> waste m ment method that is available to me and that 1 can afford. <br /> O Prin /Typed Name Sig Month Day Year <br /> t O ) <br /> Z T 17. Tronsiorter 1 A<krmwled meat of Recei 1 of Materials <br /> HPrinted/Typed Name Signanu Monts Day Year <br /> 101 ill 1#1217s <br /> W e <br /> f g 19, TMWPbder2 Atithtrwiedgemlentrof'Rech of MabFsak _.. - .... .. - .. . __ .. ... <br /> W T Printed/Typed Nome Signature Month Day Year <br /> LL e <br /> Oe <br /> W /` ,�j / <br /> U A 10�A"L G/}C(,O V S = �l 7 NUT 3 900 v <br /> Z ` f}CN C 6 7'l Mh7E� <br /> _ k <br /> I 20. Facility Owner or Operator Certif coWin of receipt of hazardous materials covered b this manifest except as noted in Item 19. - <br /> T Printed/Typed Name Signature Month Day Year <br /> "'4o tot, L iy <�� G . u d 1Vs 9 <br /> DO NOT WRITE BELOW THIS LINE. U <br /> �{.,. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> Px 8022A (7/92) (Generators who submit hazardous waste for transport outof-stale, <br /> EPA 17700.-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />