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Department of Health 86rvlces <br /> Skil of CaPlornla--Heallh and Ylellem Agency Toxic Substances Control Dittman <br /> Fbrpr Approved OW No.2060--0038(Expires v30-91) :, 44 Sacramento,Callfoinla <br /> phgea prill or llr e. (ram doolpn0d for use or,0140(IP-pli'M fYWPWforl• <br /> �{dl�®R �e t�R�}Q�s t.Oonsretor'e US OF 110• Ma:l"aat 2. Paas 1 Inlarmatlan bl the shaded steel <br /> a a a aired h <br /> WWST� ������� , of la not req y Federal law. <br /> S. Oel,pretoel;Name and Mag-j Address <br /> A.. C <br /> 4.0e11eral01`4 Ptwm <br /> 7 4 6.7renrporte l Company N ms a. - Us EPA 10 Humyar <br /> h � D210050is 700 <br /> y.Tr "parlor 2 comps Y ■me _ & a E Horn +r ?). r-. <br /> / l5 rel <br /> 12 <br /> q.Osaltinated Facility Home end Site Address 10. Ile EPA W Numbtr" r"a <br /> 412.Conistnere - OvI3.Total IA. - '.. _.1,.,:_'."._ <br /> 1 i. US OOT Description(Including Proper 6hlaping Name,flaaard Glass,end ID Number) arHlly Unit waal�mo. <br /> 00 WI/Vol <br /> No. Type <br /> CXjFowjjA REWTB MM ONLY NON FM 0 0 10 T 0 0 02 11 Y <br /> 00 N1 State <br /> 00R <br /> A EffPA/01hi <br /> T <br /> ¢ Malt <br /> d <br /> 1' (cPAl0lhs� <br /> t � <br /> y� a1k+9a� s r <br /> 13 ME, <br /> u i��SNC.i�.a1 � _ Ott ,I .y•4,.•.'•-'• <br /> t. ' .q :l�,.e,. 1�.T .7 S v,l..t+fir ..•--s' .. ,- <br /> . .,� 1 ,• peClal fYndling Inetructlans end Additional informati9e - i -�•� _ <br /> QRNCRATOR-111 CR"IFICATItNf: i herely declare that the eontenta 01 this consignment pre fully and accuratelydescribed teo fe boyC by robper shipping"me <br /> yend era clap4led,pecked,marked,and labsled,and are In eg respects In proper condition for IrenspoA by hlghv!•y g(p e ! li Inremattonsl and <br /> . . nallon II government regulalrone. <br /> If un p largo queniky gpnoretor.I cprllty that I have a program In place to reduce the volume and tozfchy pf Wetep ppnarated to Ihq-or disposal¢urfenlN rvayphle le e 1r311c1y minimltea lM <br /> m"dIrri f haus delormined <br /> i' to be economically pracllcabie and that I have sefecled the pracilcable method of treatment.alorage, <br /> .4 prevent end future!hoot to human hoalth rind the environment:OR,If I erns email quantity generalar,1 neve mjde a good faith effort to mEnk.Rti my wilts <br /> h p�rsllon end aefool Ih*beat waste managemant method thal Is evaliable to my end thaLf can allord. <br /> 'L prinfpolTypi>�Name "J' Sl9nalute ..,. - Monfh PaY Year <br /> / f r <br /> T 17.Transporter I Acknowtadgemant of Racelpl of Maledals " <br /> Month DAY Yaar <br /> N prine►drTyped Namc Signature <br /> i. ` -. . .. <br /> p 1f•TnnspWar 2 Acknowledgement of Receipt aI Malprials <br /> - - O Mortrh Day year <br /> } R P sd7Typed Name <br /> 1 <br /> J <br /> 3 1B.Discrepancy Indlca,ton Space <br /> 1 ,I <br /> p <br /> A <br /> C <br /> L <br /> I 20. eglty O'ngr of Oparalor Cerliflcallon of receipt of hazardous materials covered by ih.a msnlfpat escspl ap ogled In nem IS.' <br /> Month PSY <br /> Panted/Typed Name - Signetufe <br /> PH#apit{I(I lfiia) Dc Not Write Below This line <br /> I:Pl�E gD-- , <br /> qty,�•qe)pr22 ,,evloua pd4lono ere obsofola. YELLOW; GENERATOR RETAINS <br /> f <br /> r <br />