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Department of Hesilh Services <br /> +� slate 'sago ia--Health and Welfare Aaoecy Toxic Substances Control Division <br /> } fOM „,jW()Irk No.2060-0O3p lHapkes si•3o-�p — 9acnmrnlo,California <br /> "aki'49 Wt ar type. (Form des reed far use ae 61110/f7'Akch fyaarrrt14 .. . <br /> UNIFORM HAZARRRUS !.Qeaa►419rf up EIr ►)q: gMITN,'t o i''f"490t ' informgtlQ4 In the shaded areae <br /> 4 WASTE MANireS iof Is nol required by Federal taw. <br /> also I Sit 491139,at 0! <br /> a.OeniraWo Name end WIMP Add'dress `25 ,x,, y ► ':l.- <br /> ! �-•� 49i Er�s�' 'ti 1 rs� <br /> f.Genoralof's Phone( } <br /> { <br /> $ 6.Trani orlpr I Comp*nY Hsmt B. uS EPA ID Number �� + <br /> 31 r <br /> T.Tr n orter 2 Compriw"ame .,a. .. U$"A 1)N. . <br /> 0. sah^ated Facility Hams and its A brise 10. u8 EPA ID Number - .a• ,_• _ <br /> CES <br /> OF WFOR NIA - PV1CM16174 oil 71 It <br /> s Cir w 1 <br /> j Y 2. ahe•r a 14. tr , <br /> 11.US DOT Description(including Proper Shlppinr•dame.Hazard Class,and ID Number) Ouanllly unit Ml!!'Ha$ <br /> Na. Type WI/Vol ' <br /> Stale <br /> ICO <br /> a. <br /> CALIFORNIA BEGUTED K49M 00 HM &CAA 0 0 D T D O Q 2 0 y <br /> Stats <br /> b �PAlothar <br /> T <br /> CA c. 't <br /> I <br /> �ArPf <br /> $GH k <br /> y¢ d <br /> r. <br /> Y W <br /> 5�yq[Yi,�tl <br /> t., F. ♦s 2 1 K r c 3,�•3 i ry t i fi'+L`s'i � P •`9 C 1 i Y tti f 1 i j- <br /> P <br /> a.. <br /> -• at '�'41�,::��x' ➢�` � ���s�lt'� Y, i (? iii{ f � _ <br /> �.r�)'1i r h.: •a:. _ `cw7.a_ ,i ti�'`r }rf,.t#,a �7�t?.t.,r,1�.�,., r? �'f`.4 �.�J�t�4_, :; A/`��. •fl� <br /> 16.!Special Handiing Inrimcllons and Additional Information <br /> POILE # M - %2 <br /> 16. <br /> OMIRATW-a cafirrICATION: 1 hsr,b/doctors that the coetsnla at this consignment are fully and aacuralsly descrlbsd*boys by Pubis l lamatlansl end <br /> and are classified,packed,marke0.end laboloC and are In all respeeta In proper condition for IronspM by hlghiysy according to app <br /> neltanal poysmmsn!regulsytlons. - <br /> 111 eono�mloegytprac,lairbts and 1hat11 have 4slgclsd the pnc izeble meth d of tr•atmont,ISCS to WIMP the eslaaps,OflfdlsposslOf tcurrently ee ailato bli o me which ree I vminimize@ the <br /> to be 4 <br /> present and future threat to Kumon health and the environment;DR.If t am a smell <br /> paquantity generelor,I have made s goad Iellh,Nora to minimize my waste <br /> nerellon and select the beat*tale manag*mant method that Is evel abie tome enq Ihel Iconpflord. ' <br /> nature •• Mon1h Day Year <br /> signature <br /> � � <br /> i <br /> 17.Transporter I Acknowledgement of Rec*IFI 01 Mat.rlals Month Day Year <br /> f;Inted/Typed Name Signature <br /> H - <br /> .a <br /> senaporter 2 Ackn0;Wd`gement of Recatpr aI M,lrrtate <br /> $tgnMur...-.. .. ........ ,.. ..Month. Day Year <br /> 1r Pna1e�7d-/Typed Nome 7 - <br /> E ( r Indlh -) I/(1 <br /> w^r <br /> • til. Iepancy II0n Space - . <br /> F <br /> A <br /> L <br /> 1 20.FaaWly Owner or Cp 4101'Gnnicstlaa of receipt of hazardous materials covered by this manifest aaeept a noted In hem lg. Mcnrh Day Year <br /> T prinledrTyped Nam. Slgntilure <br /> WS 8022 A(1/68) _ DoNot Write Below This Lina _ <br /> BPA 47OD-22 <br /> !".Mab)Frevloua editions are abaolete. y@)Lpyy; GENERATOR RETAINS <br />