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Department of Health 9e:vlces <br /> Toric 8ubslances Donlfel Division <br /> 6t4jp of C":QnAio•-+laalth and Waleta AgetaY Secramonto,California <br /> Form fll9rov14 Will No.flow-•-go3o(fapkee 0•30-01) .•t <br /> lleteo fkte ar"ryPe. (Farm das)gnad for ose as eNfi!IR'pJfch IYAeatlfork klanHesl W.papa 1 Info[li gilon In @■shaded areae <br /> UNIFORM HAZARDOUS 1.f7Moretor■UB dP to. a l <br /> el Is not rsqulfad by Fedslal law. <br /> WAVE MANIFEST <br /> 3 dance o� r~'a Name and~lalling Addrna <br /> �.1�+9r91M'f Phors I K <br /> 1 company Y N4 d• <br /> 6:7ragpfOAl`r an meOFF <br /> or <br /> e. p ItePl1 Ip Rumb <br /> T,Trcnaportar 2 Company Name <br /> .. 10, US€PA ID Nwabst <br /> 0.Pier l PacGl1Y Nare�ry»�gqnodd 8846 Additstyf I � <br /> . fwli 1riiFsR►V(IA <br /> 4. <br /> 12:C11141wfP j3Tot <br /> Quo lily w <br /> IHy Unit <br /> No. Type WIN <br /> 1 I.US 607 Description(Including Prapor 8hlppinl)Nsme.Hazard Cies►,a_nd ID Number) S1t1 <br /> .. al <br /> 01 T 0002MM ON�Y NM WA <br /> styCRIFOR41A FWUTEDstat. � <br /> o.' EPAlother <br /> A 81atp <br /> � AlDth <br /> A t. EP, fl <br /> Y <br /> St}1R <br />� t d. �PAIDth}r <br /> nem� t 4dhiRF1917�Prot <br /> ■ <br /> �I 71 WIT". t f l ' r r f Y x{+5 fe. tF r;l . +•.t 1 7 M.b� S �,r y <br /> ''"" F l h� •t rhr S,w/� .hYJ 4 .y GL J�S t <br /> je, <br /> j4N�kg <br /> 3�1?fit �ri;9 <br /> i 74.8peclel Handling Instructions and Additional Infofmallon <br /> ILE0 M <br /> and accurately dsecribsd above by proper shipping name <br /> RA70A�i C.HpTII°ICA71tN1: I hereby declare that the cc of this eaneSpnmanl au July aeeardIn9 to apPllcsb7a Iniarnallonel end <br /> and are ale/aSllad.packed,tngrRad,and tebsfad,and ora In ag rnpeMa In proper condition for lnneporl by highway Accord res t have dalarmined <br /> nelloaal Qovsmmsnl r9pula414gs•" <br /> .I: <br /> It I am}tare+qusnllly generator,l certify that I haus•program M Place to»docs the voiuma and toxicity of o saro generated to the deg <br /> 10 <br /> be aconomlcaAY graetleahia end That 1 tout to <br /> the praettaabla method of lwatmect.storage,or disposal cur good faith effort <br /> tome which minimizes Wall the <br /> pin?pilon and piacture ghagk fbaet wast health0 RUMBA end <br /> the onvir method that 00 If of I AM 2 small tome And antic I can`100(11!have made a good faith effort to minimize my weals <br /> atonih Day Year <br /> PrintedlTypsd Name/ <br /> ^�' <br /> 777 Transporter 1 Acknowledgamant of Rscslpt of Materials Month DeY Year <br /> signature <br /> A PrinladlTYped Herae ,h <br /> O18,7ranspa.ar?Acknowledgement of RacNpt a1 IAaterlels - Month Dry Year <br /> A - Slgnatun I 1 ' <br /> { 7 PdntsdrTYped Nam* t_LI—L <br /> IG.Discrepancy Indication Space <br /> s F <br /> A <br /> U orator UrSRicatloa o1 racelpt of haxudoue mat�rlots covered by 11118 manlleet except q noted M Ram 74•'ti IAonlh DaY You <br /> --- --t-.. 2g.-PadNtYC"•mwar Op - - - signature __. _. _ _ <br /> N - T PrintedlTYPsdName _ <br /> Do Not Write Below This Line <br /> pNy 6622 A 411881 <br /> Ep*8700-22 YELLOW: GENERATOR RETAINS <br /> 11)yr.I-aa)Previous edillona are obsolete. <br />