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_ A,, tt�iA- a 7.e. j C�C •:. ' ' ca . <br /> tketedipn ter • K � ' , v� � it '•`4�.. <br /> Foren AopmmW OMS No.2050-0019 Mxpkes 9- a 4) y In�fry ons on back of 1 ) O.partreiat of T*Wc q It0a+o w Cordro <br /> Meow prW or type. lone designed hw use on eWe 102V")�,p.wrrwr• 4'E';, -.. :. «-Soaawro,Caifor� <br /> _ UNIFORM HAZARDOUS 1• C.ar»roW'US EPA 10 No. Ala Ood Document No. 2, poo. ,fon„d;o„it the#KW@d a— <br /> WASTE MANIFEST k na required by Federal low <br /> of <br /> 1. ratorand Mailing Address <br /> �• �iv•ti:A �,d�,- /�glfe cTS � - <br /> h a. Csierator•s Phone <br /> S. Transporter 1 Company Name 5. US EPA ID Number <br /> 7. Trantpo~2 Company Nome S. US EPA ID Num <br /> U ' <br />�Z 9. D&siprwbd Facility Name and Site Addren 10. US EPA ID Number <br /> rqz Bricksont Inch <br /> 293 Pa <br /> a ts � . <br /> u <br /> U 112. Conlairere 13. Told 11. Unit <br />: Z 11. US DOT Description(including Proper Shipping Name,Hazard Glass,and ID Number) No. T 1Nf d <br />:V3 iiasts Empty Storage Tank <br /> O NON—RCRA Kasardous Waste Solid► I PJA TI P P <br /> C4 E <br /> co N b. a <br /> E }, <br /> R <br /> i T <br /> OP T C. <br /> ac R y . <br /> Uj <br /> µ� d. <br /> W <br /> Z <br /> t � , <br /> N ; <br /> W <br /> C <br /> 1 <br /> Q15. Special Handling kwTuctiam and Additional 4rformallan _ <br /> zKeep away from Rourcas of Ipt ALnayrr �rsat halydhata trl�frR oaork'it� arofwd - <br /> W UsSiT:'s 24 Nrc Contact Nmw vt."L 6 Phos <br /> I& C&NERATOR'S aRTIFICATK" 1 h"&4 declare that the ca 4. of Ow conogriment am furry and accurately described above by proper shipping name and are dass!14 <br /> t pocked,marked,and labeled,and are in all respects In proper condition for transporl by highway according to applicable federal,slate and intanx"iawl lawns <br /> If 1 am a large quarrtily generator,I certify♦hal I have a program in place to reduce the volume and toxidly of wasfe generated to the degree I have determined 10 be <br /> J <br /> economically practicable and that I hate selected the practicable me"Of treatment,garage,Or disposal currently available to tree which minknim the preset and falwo <br /> d threat to human health and the environment;OR,if 1 am a small quality generator,1 have made a good faith effort to minimize my wast*generation and select the best <br /> w <br /> wage mord method that k available to me and thiol I can afford. <br /> Q Printed/T Name Si f re i r Dal' ,YOM <br /> Z 1 17. Tran 1 Acknowledgement a#Receipt of Materiok <br /> W : Prime Name 1 ear <br /> C9 s D - 4712 <br /> W <br /> c, IS. T 2 Acknowled meal of Recd t of Mat*ridt <br /> T PrWW/Typed Norte Signature Marsh Day Year <br /> U. <br /> fJ � <br /> 1 <br /> W 19. Discrepancy Indication Space <br /> N <br /> V A <br /> Z C <br /> L 20. facil' Owner or Operator Certification of receIPt of hazardous mawrioh covered by this manifest except as noted in Item 19. <br /> ' Math Day Yea <br /> T Printed/Typed Name S'gr'r1e <br /> Y <br /> DO NOT WRITE BELOW THIS UNE. <br /> DTSC 8022A(12/91) <br /> EPA 1700-22 YeRowr GENERATOR RETAINS <br />