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AM <br /> 41 <br /> 10 <br /> K ; <br /> - , <br /> r <br /> r. a -.• - Department of Health Sorvlcee <br /> 8teia al Celllornla--#IsaXh and Walter*Agency Toxic 6uhetancea Control Divition <br /> porrn Approve!Op10 Flo•79gD--4Mg(Expires 9.30.91) Sacramento,California <br /> P1sa,e loris!or typo. (Form designed for mire oa elNo(11 plfoh fypewriler). kfenHeai 1•Paye t InlormsHon 4r Lhe shaded.1025 <br /> P-1111IFOHAZAROOU$ t.Opnerplgr'q US E l¢NO. oa a m <br /> WASTE MANIFEST of 1a not fg4ulnd DY Federal law. <br /> } r ams and klelllnq Addrsaa ,� , ,,,z -'j— <br /> a IMP TP�IST <br /> �.— <br /> .,.�Y <br /> lie <br /> sof 8 Phone( ) <br /> q.fiengr 1 .. _. <br /> A a. Ura EPA ID Number $;`_' ".•,� <br /> 6.Tranaportor <br /> 10 ompany Name t <br /> r +� Dlhe05a <br /> 7.TraMporlar 2 mloany Name E• U8 EPA ar <br /> �i,r� l�lSyE1 TF7i1ri< r..%[t �.. <br /> p. .s�nstad Facility Name and 5110 Address 40. UE EPA yQ Numbor <br /> D <br /> CS OF IA K'11 <br /> 12.Con p 13.Total N. <br /> .•� Quantity Unit wpolf,OP. ' <br /> 11.U6 DOT Description(Including Propn Shipping Namo,Harard Class.and ID Number) No. 'PYA7 wtival <br /> 9[ata" <br /> r a **fi1�y�t ►AL MATED <br /> AA�yy�1 /�1�,yy �g /� pig •' 00020 <br /> � e� y <br /> li O �.iF1J8 IA �iG►ArLA TED WM ail y Phi rCPA 4 �I� M..p V � � 6 � i EPAIothOr •..,,, :... <br /> N <br /> EFAMW <br /> A i. <br /> T State, <br /> 0 1 � <br /> A c. <br /> 4� <br /> t� ■ s <br /> rI 1 i F �� eF. 7� \ alt y!. ' <br /> �i. �.:,.. 'rr ?l'fnf '�.'•� '! '•Y,J�„;��L''1; f #. r }} a.ru-3' <br /> � �. �t�lx � a�'� x� ���itf.�'.d'p'i. 9" '. r. :•, 'S. <br /> ' �s .Y--� s ,, -_._.e Ck f.a it � y r FyC 35}��`A.y�� i A"x• ,�.�r",,,,C�,pax�s�crM1� �:1 V 4� y k! T --,y t <br /> }�.f. ✓� '.qi Se�`�Y;�r rot Klr�^r) r �15�✓!'r�lr':•e f�G�"�� �'1•P r� s.°J � r'° �i`tn. �` r <br /> 10• <br /> 8Pecl01"Ar jinrK.7wa and Aaditi-ai nlormallaa <br /> %2 <br /> - proper ahlppina name <br /> qXg9a h1 g applicable International and <br /> ro aovill pe ed.hereby pnd labeled,end or?n loll f'eaPoeEfa Iln proper co dltbn}foi Iri,ncporR by occur 9hW Y•accgrdln b o app P P <br /> nsOonal 4ovpmment rpqulatlgr.e. <br /> [l err+p targe qusalXy 9eneralor,I certify!blot I have s program In place to raiuoe the Volume and toxicity of Lge,1e generated to the dp9ras I have determined <br /> 1v be aconomloaXy practicable end that f have selected the prseilcabla method ol treatment,storage,or dlopoeal currently available to me which minlmlxes the <br /> prpsenf Lad 101114 throat <br /> disc!the <br /> it waste health <br /> emenaand <br /> the <br /> met(had that IQs,i 111 Am vallabl to meucad that pcan aflordl.have mads p good feXh ellort to minimize my waste <br /> g"srpManrh Day Year <br /> s PrlpipolTyPpd Ns r 619nalurp .. <br /> F r ... <br /> 1T.TraaaporiH i AClraoaded90mant of Receipt of tdal.Xata tureMenrh BeY Yaar <br /> �,' H PrI f�rTy�Nene Signa . <br /> r <br /> 0 10•Transporter I Aaknowledgemed of R,celpe of Alaieriala` Moath Bay Year <br /> Print lTypad Name 81gr(Sture + 1 J ( s O 171112 <br /> 1 'l v <br /> f9.Dfserepancy IndicaYlon Epece <br /> A <br /> C <br /> 2f).' aelllty Owner or Operator CertUlculon of recalpt of hazsrdoop m4terlela'poyarsd by thl,manlfwl except■a naiad 1n Xafm 49. Month Day Year <br /> TedlTYped Name <br /> y role 8lgnarurp <br /> ~ . <br /> 0y6 00221(1144) Do Not Writo Below This ane <br /> EFA 070D- <br /> .22 <br /> Previous saiulons ora obsolete. YELLOW: GENERATOR RETAINS <br />