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Nov 20 03 09:08a PA' Environmental fP 11233-4284 p.2 <br />t.. <br />1m <br />Slate of Calilafni9--Fnwronmenwl P—ac-crion Agancy �!/'�'(J�l:/� 4'1u 7 V �'r'-W <br />(y <br />Form Approved OMB No. $GSC-00391EhpUn 9-30.9f1 "� a - See In truchon Bock O[e 6. Da pdrtrn•tlr of Toaic Subsrancv. Cmlr <br />r P4ose prior or ypa form dealpnad to, we on elite j1Y-pircJ+l ypvwrfrer,Sacrom.nlo. Golifornia <br />DO HOT WRITE BELOW THIS LINE. <br />While: TSOF SENDS TH15 COPY TO OTSC WITHIN 30 DAYS. <br />0T3C 9022A 11/?fl To; P.O. BDx 309V, Socromanta. CA 95812 <br />aag-.j 7nnr7nn J 11c_I 027nTnrrnai ._.,...._... _._.... •.._.. - -. <br />11 rPUTT nn.n= rmYinY XTA o)r- oa GhA <br />ID No. <br />Manit.at Docamrnr Nv. <br />2. P.V. 1 <br />nfvrmoa on : Rho sl ceded areea <br />UNIFORM HAZAADOVL—=O <br />It rel required by roderal la �' <br />WASTE MANIFEST <br />p <br />Z. Z 0 <br />.1 1 <br />93-79 Ca <br />J.G.nwaoraN..... andN.II a Addr.l.�,,�,,�PAPA441--)4s <br />A. Smet Mcnsfatt Oo<w sen/ Number 22542520 <br />/wj/ M411Li04;%4 XoAa <br />li. Sla1. Gerrroler: lD <br />S rain row GA y3L`'-� <br />a. eanerafar, Phan. tom`! I Z33 Z�'� <br />• <br />S, Trgnaporler 1 Company Nettle b. US EPA 10 Plumber <br />C Swta TratupocTer'a ID ( .{ <br />D. Trompart+r't phare. <br />ss� <br />� <br />C v� Nt 9 � <br />,. rran.p.r.r Z Ca p.ny Nie"a. VS EPA t0 N.tnben <br />rz 3bti Tro laaonara ID area I <br />c, iaan.pera•ra Phan. <br />� _ <br />9. D•s;@naiad Facility Name and Sill: Addr•u 10. US EPA ID Number <br />G. Shah FacIG1y's 10 <br />C S o to 7 5 <br />Ct.+tAN MIA30toe-s <br />_ <br />Zsoo h1 • Y.,akE� <br />K. Foeilih/a Pilon. <br />`� 3xp A 80 <br />�SZ7h / 76LG1�v <br />12. Cwtale•ra 13, To-oi A. Uni1 <br />11, V3 DOT Usxrtphan llmiuding,Prvp— S'hlppin514 ••, Nozvrd Clol•, o -d l0 Nuan6taf <br />No. type ave -lily Wt/Vol I. Woar• Nur•ber <br />a. SON ��tA NAzA.e�vvs AJ,osr� SeL�� <br />late 3S2 <br />� �wa�r <br />G <br />O 10 f D 10 10 JZ 10 <br />E <br />Start <br />EPA(Other <br />a E <br />r Q <br />t <br />' A <br />Slate <br />O <br />EPA/ah.r <br />R <br />d. <br />smt• <br />EPwladaer <br />- <br />1 <br />1 <br />J. Addalarwl Oesufpd area for iala titled Abe.. <br />Gr1 2,2.,L3 -ZZ - <br />%. Haodling Cade for Wattu <br />a. <br />lis vd A6a-r <br />6. <br />d <br />i <br />"DinsD507 p�l�`i3431 <br />] <br />1. S,aot Faandting Iharauciians and Addtrlaaa v <br />$pa <br />'- <br />/f !//�'D��vr`isrtc3lE ir2cT✓/�i� 7z) G�Arb.� <br />J <br />16. GENeItATOWS CERTIFICATION: 1 hereby dadare that rh• c iesnls d This conNgnment we fu4yorsd occurarJy doxrib.d abm. by pe.p.r :hirsaing naa..e and or• 16"Aed. Packed. <br />:n.vrnnilnn nalloo 9a.ernres., regJfa(jons. <br />Q <br />mwk•d, and lab•4d, and we to all ra rpucrt in p—p•e cpodlion lvr Iro-ap,xt by klgh—Y ae <br />141eg r.-ppllcabl. al and <br />J <br />tf 1 om a large q.—ti @Dymelor, I evnify ehas t ha.. cons is plea ry radar. the velum• and loxlei7 .F ..ears q.n.ror.d >e 11.. d.pre. I h— dNermined ro 64"c—im" <br />ds• nrelhod� hvatreear, ;tum". or diapsxal curnnrly to sna —Mch minimitm 1h. p enr —d hr+ura Iht.vt ra hurrwn 1,-4 <br />practicabf. rsnd ]hot 17-6 telatod proakn6lo .-3abfe <br />rd the ewtranme rel; OR. if t am a small quantity g•nororor, I haw mode a good foi16 e16M to minimize s cat. gerseralion and sefad 16r heat—te mmhad Ihar it <br />sc <br />avaifablc ra me and tf.al t can ellar.d. <br />s„ <br />snns+dl Typ•d Nome <br />5irinoturc <br />Month Day Yc - <br />J <br />r <br />•L <br />r17. T-.,---1 Ackna�lad omen, vc rsR-a: r of t-bm ;e6 <br />Manrh Oar Year <br />x <br />PrinlYd/Typod Nome <br />Signature <br />Lu <br />p in. Trane orfvr 2 Ackn.�lvd c aM of R—i 1 of Marssrida <br />Manlh DaY V•a r <br />TPrinted/Typed tJa.rw <br />SignDlure <br />E <br />dR <br />U <br />iv. Oizcmponr7lndicalbn Spic <br />r <br />2 <br />— <br />F <br />A <br />l <br />1 <br />I 10. Facill Owner ar OP9,0M, Certlfl<orion of recol of hazardo.r. rsaawfDls <br />carsxvd 6 Ihh manifelTerce t as IbPBd in loom 19. <br />Moods Oay Year <br />T printed/Typed N • <br />Siaaatwe <br />2 <br />7 ✓� C <br />d <br />DO HOT WRITE BELOW THIS LINE. <br />While: TSOF SENDS TH15 COPY TO OTSC WITHIN 30 DAYS. <br />0T3C 9022A 11/?fl To; P.O. BDx 309V, Socromanta. CA 95812 <br />aag-.j 7nnr7nn J 11c_I 027nTnrrnai ._.,...._... _._.... •.._.. - -. <br />11 rPUTT nn.n= rmYinY XTA o)r- oa GhA <br />