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II <br /> j ma o+ California—Env, onmemal Protect n Agenq <br /> rat- Approved OMB No 2050-0039 (Expires 9-3696) See Instructions an back of, Je 6, Department of Toric Substances Com- <br /> =leom Print or type. Form designed for use as eine (12s itch) typdwriler. Sacramento, California <br /> UNIFORM HAZARDOUS 1 . Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> i I WASTE MANIFEST f f'J . r . die " s of not required by Federal law. <br /> I 3. Generator's Nome and Mailing Address qWiW <br /> ^4i a +tea - r' rs Avg tst <br /> / i '�1r6. 1It <br /> `�I <br /> n / ..IC_lorrsirHI <br /> 4. can racers Phorn (.TCy <br /> S. Transporter 7 Company Name 6. US EPA ID Number p s T,hP y <br /> o <br /> ,+rt.,.✓.f, e. >Srt' ..Y� d..� '� + <br /> vs . 7: Transporter 2 Ca pony Name S. US EPA ID Number <br /> J <br /> - 9. Desi toted Facility Na a and Site Address 10, US EPA ID Number <br /> " w u x b, tti <br /> Ef <br /> 1011'an RIM <br /> forest Containers 13. rest J14. Unit <br /> •'* ' .5,1 <br /> 17 . US DOT Descriptwn Including Proper Shipping Nanta, flood Class, and ID Number) 72. tS , <br /> Ouaniiry Wt/Vol <br /> 'm = <br /> Its N- b. <br /> 1 <br /> w ; E <br /> nl R PRY <br /> A PON <br /> C. Isis <br /> ^.I ® It <br /> ddi <br /> It; der 36 wd, F <br /> ul <br /> s�hbkStfR �kd R _ 1 a + s!go 7 <br /> - <br /> z r <br /> r 6dv <br /> ''S ' - tui f P ) `h` is kA d4 <br /> MOR,{ <br /> + (t_ <br /> _ f I Ed <br /> 75. Special Handling Instructions and Additional Information <br /> IL4 to <br /> : <br /> e <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that Me cements of this consignment are fully and oacurafehj described above by proper shipping name and are classified, <br /> Wed I packed, marked, and labeled, and an in all impacts in proper condition for transport by highway according to applicable international and nmionnab government regulations. <br /> If I am o large quantity goneratar, I certify that I have a program in place m reduce the volume and toxicity of waste genmated fn the degree I have defermfned to. be <br /> aconamicolly practicable and Mai I have. selected the practicable method of treatment, stooge, or disposal currently available to me which minimixes Hie present and future <br /> N threat to human health and the enviromnanb OR, 9 1 am a smallpusplHly geMiaror, I her ado a good faith affect tisminimize my waste generation and select the beg <br /> waste management method that is available to em and that I can ffor ExEd <br /> '. 0 dat .;. /Tps s r <br /> Xd <br /> DW r .Tyr `fytp4;1 <br /> � <br /> Z T 17. Transporter 1 Ackowled emend of Receipt of Materials ....-. <br /> WA- Pd /Typed Nome . ZIf F elm ;")Da <br /> y v, <br /> a 19. Transporter 2 Acknowledgement of Receipt of Mmndals <br /> y� <br /> T Pctntad/Typed Name Signro ate ` Month Da Year v <br /> n ! E y <br /> R <br /> 19. Discrepancy Indication Space <br /> U F <br /> A <br /> Z C <br /> I <br /> I. ddddd� <br /> 20, Facility Owner or Operator Certification of receipt of hozordos materials covered by this manifest exn t as noted in Rem 19. <br /> T <br /> r Printed/Typed Nome 5antem Mamh Day Year <br /> DO NOT WRITE BELOW THIS LINE, <br /> TSC 8022A fl/951 Va4vid GENERATOR RETAINS <br />