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<br />,Ir .. tun gency
<br />uvrd OM8 No. 205(1-D039 (Expiros 9-30 19) See Instructions on back of page 6.
<br />t or type, r6.,,designed for
<br />d l
<br />use au elife f 12•pirch)
<br />lypewriter.
<br />Deportment of Torn Su6stn aces
<br />Control
<br />UNIFORM HAZARDOUS
<br />WASTE MANIFEST
<br />3 Cencralnr' N I M 'I
<br />I. Genarnl.),', US EPA ID No
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<br />ManifosrpocumentN0.
<br />i 4�� I �4
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<br />2 Pogo 1
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<br />Sacramenlo, Col;fornir:
<br />Inlormc.lion in the shaded meas
<br />is not required by Federal la.,
<br />e oma an, of mg A r r»ss
<br />QFi FCF:RUILDERS
<br />2325 W. Cjm-Tj�R WAY STOCKTON , CA 95206
<br />a. Gar,eratars Phann 1209 ) 467--0490
<br />S Transportwir 1 Company Nu,ne b. US EPA Ip Number
<br />-HA - ZARDOOS TEt:.'� NOLUi7I M , INC . P Q A -0
<br />7. franspnrler 2 Company Namc 8. US FPA ID Number
<br />9. Datiynaled Far,;Gfy Noma and ;i,, Address 10. IJ$ EPA ID Number
<br />1--1 V:rnt0-itiRM)N
<br />2000 v. -AJ MFDA ST
<br />COMP`MN,CA _ 90222
<br />11. US DOT Descnpllon Vnrh r1;,iq Proper Shipp;A,l Name, Hazard Class, o.srd ID Number) 12.
<br />-• --. _ No.
<br />IMARDOUS WASTE ! N.O.S (CADMCLM - —
<br />C MOMI UM LEAD) 9, NA ' . 082 111 (DO07 , DQ08) A ! �
<br />"NON RCRA HAZARrous WASTE LIQUID
<br />(BRAKE FLUT D )
<br />ANON RCM HAWDOUS WASTE LIQUID
<br />( EMULSIFIED COATT14G SOLUL ION )
<br />A. SOONManifoil Ducumant Number
<br />99834954
<br />R.^$Tatler-G-e'r,�erols-tar's 1!]
<br />C. Stole 1ranapn0en's IDRes�
<br />D. Tmnsporlc is Phone
<br />E. $tale Transporler's ID IReservarl,j 7J J - '
<br />F. Trnnsporfer's Phun-e
<br />G. Slane Fn6lity's 10 -
<br />H. Faciliq/s Phone
<br />(310) _537--7100
<br />ninon 13. Tocol 1-4. Unit
<br />7Yee_ Quantity WI/W11 I. Wasla Number
<br />St.,.
<br />3 2�3
<br />D L� ASIO /Yy EPA/O,bbo
<br />23
<br />P I,V EPA/OtPfUAsr.. .
<br />s,nly 223 _
<br />D 1 M101 G FPA/01heer -
<br />StatNONE
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<br />Ern/Olhar
<br />1. Addlfionol Descriplioos for Matnriala Lleled A6ovo - �� - - �"� - •- - -
<br />K. Handling Cudes for W.,stes ustod Alcove
<br />wl
<br />15. Spec;cil Handling fnsNucGyns and Additional Ldormalron ' ---------
<br />APPROPRIATE
<br />APPROPRIATE CLOTHING
<br />24 a�UR Eh F.RiG, N(.,y R8.5MNSE - CFiW TFL, IEiC'. 1-e00-255-3924
<br />16. GENERATOR'S CERTIFICATION: I hereby declare that Iha cordelrfs of this constgnmant ore fully and accurnryly describad aljove by proper shipping name and era 'lassihed, parked,
<br />marlaA, and labeled, n�,r! ore in all raspnCls in proper condition for lrmsap-t by highway accoedinst to applicohlo inlernationol and riatianol governmmd regulations.
<br />If I am a leq)" yuanfiy gen nutor, I certify ,hot I buve a pregrom in Placa t,r reduce the volume and Irmciy of whsle generate,-] Io the d-1yee I have determined to hw economicall
<br />yy
<br />prrlrncuble and thni I have seleclad Iha tradeable method n hecilmenf, storage, or dislso>r.l cvrrently avoilable to me which minimi]«1 the present and futnra t6•eat to human h«nhh
<br />and the anv6onlnent; OR, if I own a small qunnlity generator, I have mode n l,und faith effort to minimize my wno. generation ....d selccl th« best walla management t m«tl od that is
<br />nvn;lnl)le to me and d-ut I can off—J.
<br />P i d/Typed Nam �� ignatvre � .
<br />1 7. TranscTr`now ail of RecaiLst of Mobrials---
<br />Printed/type/.Name Signature
<br />38. 7rnn.t,Rrfer 2 AcWnowledgemenr of ai.e;l,l of Molerials
<br />Printed/Typed Name
<br />Signature r
<br />fr
<br />19. Disci«poncy lndicma- Space
<br />20 Facility Owner nr Qonrator_Cerlificut.nn of receipt of hazardo.smnla,ir.ls ,-:armed by this manifest rxaapl as noted ;n h— 19,
<br />Prinlad/Typed Namo Si»noture-
<br />DO NOT WRITE BELOW THIS LINE.
<br />Month Day Yoln.
<br />(���,
<br />Month Day Year
<br />.. _.--r—onrh .. fay ..Year
<br />1. 1I ... I . l --L
<br />Month Day Yeor
<br />DTSC A011A (1/99)
<br />EPA f)/00-22 Yellow GENERATOR RFTAIN$
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