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Stars of Cuii oiM1ia—Env,ronme +al Prdlectran Agency See Instructions on back of page ti f <br /> Form App,O ea OM5 NO 2050-0039t1Enp,res 9 30 991 P DepOrlmeM1i Of TOXIC SYa fiances Cor <br /> Pitose or ni of rvoe form designed for Vat on erre()2 pachf typewriter Sacramento CoLforn a <br /> ! <br /> Gen rotor r US EPA ID No Mandast Document No 2 Pape I lnlarmotro.in the shaded area% <br /> UNIFORM HAZARDOUS �" a is not regv,red by Federal lq_ <br /> WASTE MANIFEST <br /> j rervctor+Nome and Mo.hng Address (� A," ii. s r <br /> J� /7 c �— ^r c1 5 Z f P% <br /> Genetaior% PhoneL rt�-' `r L ���� 1 lJ ��t_ t rr f r SCJ by <br /> T,clospomer I Company Nomt ----- — --6-US EPA 1D Number=— <br /> CO� -� el d t <br /> aILL r r 11 r r L I I I <br /> m i ' lronsponer 2 Company Nome 8 US EPA ID Number <br /> 9 Designated Fgnl,t�Nome arra Silt AtC{dresl T ip US EPA ID Number <br /> do <br /> Sl�j,i I f\T1'�11rMillie <br /> 13, <br /> O <br /> 12 Contoimri 13 Tot IA Unit ^{Y <br /> Vt .r5 DOT Deunpnon Imdydmg Prope+Shopping Name koxord Class and ID Number) No T • Quantify Wl/Vol %% p�I Mber <br /> ` 4 t <br /> Z ` t, 1.1 1•t r' :1' .I�, rAI{f`0, 1ti, vbt Tr t 1i11I1t') <br /> �� r% i v k•isC, <br /> r1 e, i t r, 1 t { ��- •f <br /> E <br /> of N - r <br /> cc <br /> c <br /> l <br /> 'A.,.i;- N + <br /> co O <br /> II <br /> r, <br /> Z 1 Addit+onq tij. +- <br /> O I f I`T t .34LU <br /> '0 <br /> y <br /> Ix <br /> t 0, � Special Mondi ng InsvvU ons and Addiiionol Information S l + e __ hh <br /> Z, }rF��J FLr lflr�_d its 7-tlAb Gr <br /> to �• L f e a +.J r/t <br /> Imo, 16 GENERATD1i S CERTif1CAT1ON I hereby detiare that she contenh of thn contrgnmenl are lully and accurately described above by proper shipping name and ere clossdred pocle <br /> Q mmted and labeled and are m oil respects in proper condition for transport er htghwor according to applicable mtemotionol and nartonal govarnmem regulations <br /> V!I I I am a Jorge quarsiry generator I certify 1ha!1 hart a program on place to reduce the volume and toxicity o1 wall@ generated 10 the degree I have determined to be econo lly <br /> f prpu,cable and shpt l hove%elected the�wuscabie method of treatment storage or disposal wrrently available to me which minimizes the present and future threat to humonlhh <br /> I end the emuonmem OR if�I a %moll quantity <br /> generator I have mode o good faith effort to minimize my waste generation and select the best waste management method n <br /> i o.eilo Zo odd rhar�c +-l�laf� (/( L� s <br /> .� r Ye <br /> M1+ed/lypsd Nome ti Month r ffoy"� <br /> C), <br /> i Stgrrarufe ran <br /> warier l Acknow{edaem nt of Recerpi ofµo1enuis ^ - <br /> J r, <br /> e - ^Signature <br /> s�J Mo <br /> x me <br /> n+e /Typed a <br /> P <br /> p l: Tion sooner 2 Atlno,+ledoemen,of Rtceial of Material sy <br /> month Doy <br /> e <br /> o,., o/Typed Nome Signature Y <br /> Cii p i <br /> I U i, scre <br /> > poncy tndicot,on Space <br /> F ' <br /> l �+ A <br /> C <br /> i <br /> f L <br /> I ( 2: s: i Owner at Operator Ceri,lico+,on a1 receipt of horordovs inosenals covered by this manifest ecce t os noted In liem 19 <br /> Signature Month oar <br /> T :r r,eo,'1 j;td Name l <br /> i Y � I <br /> 3 t <br /> } DO NOT WRITE BELOW THIS LINE <br /> yellow - GENERATOR RETA <br />