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r Department of Neehh Serrieas <br /> To:la Bubatencta Control Division <br /> atlh and Welters Mar Sacismanlo,California <br /> Slate of Cafllornls No.2050—.0039 SEaplrea 930'91) <br /> Form Approved OM8 2,paps t <br /> (Form dad➢ned for uat a^able(1TPl4Ch typewriter). Montreal Informallon M the shaded erase <br /> Plow prlel or type, � I.GeneutoYe U9 EPA ID No. Document N0. a! Is not regal by Federal las, <br /> UNIFORM HAZARDOUS A.SInileet oceamem Number <br /> WASTE MANIFEST e1e Me <br /> a.Oenera,ol Name and MailinggAAddress <br /> 894 <br /> i s UA T tL d� ale nsnera'.r':N <br /> 275 �IGra�t 1537�Ad <br /> jirasr dill ons — US EPA ro Number C.SIa1e TranepaRrde iR <br /> 5,Transporter I Company"ami <br /> �' D.Tranap0rler's Phone <br /> P 7 e U A um er E.Slots TransPO"ti 10 <br /> ren T.Tlanepartar 2 Company Hill F: Transporlrr'e P1fOne <br /> 9.Desigr d Fae1111Y Name and!."Ile Address <br /> tv. <br /> US EPA ID Number 4.8114•FaCI1Xy'e ID <br /> N S W 5Iy I SerV l ce CUTPal l)' H.FeCllty t ha a <br /> 2U (]TiIT- F, sit, Strell!t <br /> Self Fral lc l scot (f'► 94017 <br /> Tate ' <br /> C 12. on alners Cuan111Y Unit <br /> Wells No. <br /> No. pe WllYol <br /> Cla <br /> ►�O T I.U9 ppT Description(Including Proper Shipping Name.Hazard se+.arid to Number) NTyState <br /> re. UI L TAW p PAl <br /> F�SIC�E WASTE III7 Yt/tSTl=1 slate <br /> E (CALI FIMI A UILY I W <br /> E b EPA101ha <br /> A <br /> Bill <br /> T <br /> 0 E AlOIhH •!r <br /> 7 R C. <br /> •'. Stals ' <br /> d. EPA10thw <br /> u f K Handling nodes t«Yfatua!!tled A6art.... -'1 <br /> i b1 <br /> a1 J. ddXlenel Daevlptbnt tar Malerlelt Llaled Abolra .. .. <br /> g []lJl' $0© gallon tenl+;:last cont®InlTeg waste olI �` - Q1 . d <br /> +tank y Ice <br /> krans�ort. <br /> Ln Irwrtud with dr I• <br /> rx - <br /> _j <br /> iz <br /> FSpacial Handling Inetruallorta and Additional information <br /> gFPIa7FFtIATE FTjj ECrIVE CICIII-II L; 144L) ',I:5 <br /> 11'II;ATut- <br /> " i J erahl In➢name <br /> S4J f8. highway seer:' nP to It <br /> M1ema11on a and <br /> GFRERATOR'S CERTTFICATIDN: 1 hereby deetare that the eonlents of this conafg omni ars Tully end t byaccuratelyhiw y scr@���6ave 6y prop pP <br /> and ere clnelged,packed,marked,and labeled,and are M ill respecle In proper condition for transport 6rhe y g ed todegree I have determined <br /> nllional 9overrtmtnl reclutalions. <br /> If I am a large quantity generator,l certify that I Fare a program ti place a la reduce the volume end storage. <br /> 0h.a made a good wools tfaith effort 10 minlmlts my waste <br /> to be economically practicable e,R�,pHfhrod the enva0the nminq OR,kill am a smadtqua it regenerator,err disposal currently available to me which minlmltsa 1M <br /> r <br /> praaenl end future threat!o hum Lldnlh trey Year <br /> generation and select Ihs best nerals management!method that ll sva[tebls Ie rna end tin 1 can afford. <br /> Signal to <br /> Prinied lTYpa Hams r _ <br /> Month DaY Yee, <br /> 1T: <br /> Transport f Acknowledgement of Reaelpl 01 Mlterleta B19nH .� <br /> A PrintedlTyprdName <br /> Month Day Year <br /> P ter.Trensporfsr 2 Acknowledgement at Receipt of Materials <br /> Signature <br /> W O <br /> R PrkrtedlTyped Ntme <br /> T <br /> E <br /> a <br /> 19.DlacraptrtcY Mdlesllart$pets <br /> F <br /> A <br /> C <br /> Rlanlh Day year <br /> 20.Facility Owner or pesetas CenlOcd[on al fatale!of hatardout msUdalSF9nHurs d by Ihle menllset sacepl as noted M Mem 49. <br /> Y Printed/Typed Nome - <br /> DO Ido!Write Below This Llne <br /> 49 8022 A(1188) <br /> rA.ergo-2= YELLOW: GENERATOR RETAINS <br /> ev.988)Previous sdStlane ere 011101818- <br />