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_ <br /> II <br /> 1 <br /> Pile of Callfornfe—Heaflh a AQeney <br /> Form App raved CM13 No. 8{Expirae L 3t}91y� +r?af1 InfitrufiilDD$OE!QaGII al Pegg B Department al Health Servleas <br /> '�Ploste print or type. F as sed tar ase on alga{r2: !f t pwrlferJ., '1 and Front of;fte 7 Taste 9ubatanro5 Conlro!Dlvraiar <br /> P Sseraraenlo,California <br /> UNIFORM HAZARDOUS ,.osnera cel us EPNa. Manrfoal 2.Poo t <br /> WASTE MANIFESTDaeument No. Information In the shaded areas <br /> {' A U 2 4 .1 2 9 U 11 i! li l at Is not required by Federal law. <br /> 3.Ronsrator'g Nw:,e end Moiling Address .A, y/��a'kyr <br /> E1TitV%`Z1 RENTAL r2 ;J 8 4rF•y�y <br /> 2'15.9rant bine Road, Trauy, CA 45376 0-_'o F@( ne ';q IP <br /> 4,pgners]or'aPhane{(21190 �_�&-254'1 `' <br /> 3 Ii.Traaspoiler 1 Company Name Il. us EPA ID Number -- ;7t.a- <br /> *9 T pppp,liw <br /> w 11 A 14 ]illi fi7CVirw rets an f! A TI U li 7I711I 610 1'-? @P?FIFP " _ <br /> 1 '7.Transporter 2 Company Name B. US FPA ID Number - <br /> 1 Tf#wfBRPf>W4PhPfle- - <br /> 0.Daatgnaled Facility Name and Site Address 10. US EPA ID Numbor <br /> -3 H 11 t1 <br /> 0II1r; Service Company <br /> 220471411 Basin Meet <br /> kr9;� ,7alz rrafic i sca. 17A 94107 1! A R f1 IIJ 4 7 1711 1116 8 {P •915 � 4035 <br /> 12.Containers 13.Total 1I.US Description(Including Proper Shipping Neme,Hazard Claes,and Ib Number) Quantity U1ns3.I WaalIe. <br /> No.Du <br /> Ue, No. Type WWI <br /> Slate <br /> CO±±z�� Q t1AYANiK)U8 WASTK Ll{�E17I1, N•0•4, 0RH-9 !eA 9169 <br /> CD �' <br /> b EPA/Metp Stale <br /> A <br /> r T ' --l!! EPAraher <br /> N O r-- --__ r <br /> R a, <br /> aisle <br /> I;PArOtlla; - <br /> d <br /> state <br /> V i:PA!mw <br /> .011fw <br /> ; 'F-e_? '� t 4 �._' •1 r' r K i a ,o_t q. y JVW." Isfod Above <br /> 4. <br /> F t6;spealel Nandling trtatruotlons er.d Atlditiauel Information - - - - <br /> j F 409 449kili <br /> APPR()FR rAT19 PRtlTECTrvill [`'"1111W) AND RlAPPINATt1R,- <br /> Is. r . <br /> - [312 ATOR'6 ell ICATION: I hereby declare]list the eonlenla of this consignment are[r?y and accuratey don dbed above by proper shipping name <br /> and rn olssalflad,packto•markoc,and labeled,and are In all reapecta In proper condition for trenaport by hlghwey¢ccordlall to apptieable Informational and <br /> ".[lanai gave. <br /> man]re9uialionq. - <br /> It I am•I4►gs qusnlby generator,t certify that I have a program In place to reduce the volume and toxicity of Waal*generatgd to the degree I have determined <br /> to bo tomo" 0111y pacticabla sod that 1 have saiecmd the practicable method of treetmoni,alorega,or disposal currently available to me which minlmlraa the <br /> i presont dnd future Ihreai to human heaSh and the environment;tom,It I am a small gvenlllr generator,I have made a good faith eflny to minimize my waste <br /> genenllon end select the bast waste management method that I0 evellable to me and that(caa Ilford. <br /> Prinv <br /> '!0d1Typsd Name8lgnaluq; Mosth DRY Year <br /> . ,' i 1•'i:..` � ,��•'..'"r• ..1 ,�N;:r;1,-' cv-r.� Lf •j 1 ' y <br /> 17.Tran.porler 1 Acknowledgement of Receipt at Materials II <br /> ` <br /> A Pdala •-yped Name Sign a <br /> Afonth Day Year <br /> r� .A KW T V. WEE <br /> O 10.Transporter 2 Acknowledgement of Recelpf o1 Materials - <br /> T PrfnledlTypod Nome signature <br /> O It Month Day Year <br /> to,Discrepancy Indication Space <br /> A <br /> ?C <br /> '. I <br /> 20.Facility Owns!or Operator Cer]lllcellon or receipt at hexarylauo materlala coygrod by this manifest excspf a.noted In Item Ili. <br /> "!Y Printed/Typed Name signature - <br /> ' _ Month Day Year - - <br /> on@ e¢22A22 <br /> r Do Not Write Below Thie Line <br /> CPA 0700— <br /> (Rev.5-89)Previous edlllons t•re obsolete. - - - <br /> YELLOW: GENERATOR RETAINS <br /> 1 <br />