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.,^ Aomio--Emi anmmlal Protect"Agency ' ' �' - See Instructions on backControl1ge 6. � Department of Toxic Sabuxecan Coral <br /> rod OMB No 2050-0039(E P res 9-30-94) $commons.California <br /> -tun or type. todesigned for ow on elite(I; h venter., j.the shaded 0 <br /> 1. Gemrotors US EPA ID No. Manifest Document No. 2. Page 1 Information is FM requ,red by Federal law. <br /> UNIFORM HAZARDOUS / of I <br /> 0 <br /> WASTE MANIFEST 0 0 1 1 3 4 1 6/ <br /> . ' - - A?:_ MmekADowradnt' Eat <br /> 3. 0eoerata(s Name and Mailing Address ,. <br /> o OUY, STDP�MARY,ETS STORE 1132 <br /> - n IS ENTERPRISE STREET 8.'State a eao{ifD y§ <br /> FP.ENORT CA 04531 k <br /> � 4. Generator s Phoria ( S 10) BST-1500 °• � { "" " <br /> f W Number <br /> ID N <br /> EPA um �� Cz$Tale Traasp6Herie 1D ` <br /> [S 5. Transporter 1 Company Na - 6. � .. <br /> S <br /> m C Ut'( s phpy n _•'""1ff;. � A A, <br /> A. /� m4r v E;5fate T "SAD <br /> C <br /> 7. Transporter 2 Compam Nae 8, U5 EPA ID Number <br /> r <br /> VF.'.^kTlaosporhv',ws•1Mtorte. '.� �" .•� <br />( 4 9. Designated Facility Name and Site Address 10. US EPA ID Number G. Stae F?a.ra)''s 10 t / <br /> GASON 014 CO. <br /> 4 g�APOF BLVD; C A 0 0 4 3 i 6 0 i 0 2 +1 <br /> (9) REDNOOD CISY CA . 114063 t <br /> Q�a <br /> 1J 12: Containers 13. Total 14. Unit <br /> CnZ 11. US D07 Description(includrg Proper Shipping Name,Hazard Class,and ID Number) No. T Oua ' Wt/Vol k,.Waae-NumberN <br /> N'= a AZAEDOUS NASJE 11091D "'O.S.,O S r <br /> �N E - MAT RITH1l §S NAN 4 BENZENE}co N <br /> S <br /> E - EPA/l7Nsey <br /> r R <br /> O - EPAflDdiaZ4 . <br /> . .,� R .. . <br /> W 1Sraie <br /> U <br /> W <br /> o R- 3 Z <br /> . 0 .: xtyd ' ' Tor Abw,e:. ` .. , few,'AGove, <br /> 6 <br /> W <br /> IRV <br /> J <br /> ..0Z <br /> 15.,SpecialHandling Instructions and Additional Information <br /> Z GLOVES,. 000OLES 3 APPROPRIATEiPERSONAL PROTECTIVE EQUIPMENT <br /> W EMERGENCY CONTACT•-RICH 0ARL011--5107554.0404 <br /> t- <br /> 16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> J Q pocked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,stale and inbrnolional hws. <br /> IJjr u <br /> If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and that I haw selected the practicable method of treatment,storage,or disposal currently owilable to me which minimizes tine present and future <br /> @ W threat to human health and the environment;OR, R I-am a small quantity generator, I haw made a good faith effort to minimize my waste generation and select the best <br /> ac 11 waste management method that is awilable to me and that I can afford.' <br /> O Pri Typed NaW Sig - Month Day Year <br /> U1. --Z T 17. Trans porter 1 Acknowled em einof Receiptof Materials <br /> -TOV W s <br /> 71�. A Printed Name Sig re Month Day Year <br /> P <br /> 0 18. Tro r 2 Acknowled oor&of Receipt of Materials <br /> 1 W i Printed/Typed Name . . Signature - - - Month Day Year <br /> LL <br /> O l <br /> I- W 19. Discrepancy Indication Space - - - <br /> U IF - .. <br /> A <br /> Z C <br /> I <br /> L <br /> �. I 20. Facility Owner or Operator Certification of receipt of hazardous materials<owred big this manifest xmpt as noted in hem 19. <br /> TPrimed/Typed Monte - Sig Month Day Year <br /> - DO NOT WRITh BELOW THIS LINE. - <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS_ <br /> DTSC 8022A (12/91) - - (Generators who submit hazardous waste for transport oNof-state, <br /> EPA 87022 - - produce completed copy of this copy and send to DTSC within 30 days.) <br />