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, _�--Mar 1U U5 UJ: 59p p. 2 <br /> State of California—Environmental Protection Agana <br /> Form Aporoved OMB No.2050-0039{Expires 9.30.99) See Instructions on back of page b. Department of Tosi c Sabslonces Control <br /> Pleosa print ar type- Form designed for usa on stik lI Z-pitch]typewriter. Sacramonlo,California <br /> UNIFORM HAZARDOUS <br /> 1. Generator's US EPA IC. Monifea Document No. 2 Poge 1 Wis motion in the shaded areas <br /> is of required by Federal low. <br /> WASTE MANIFEST C. $ q 2 g z t 4f L{ -r1 <br /> 3. General-/s Nome and Moiling Address A.Shoo ktanifest Document Number 23638444 <br /> �-�sk:o 5. o+i�txo�.•TIA ZflI STLoc�ro,v, ca 9531 g <br /> o e. $rote�e xralo s lD <br /> sf) E. Generator's Phone(1,09 I 93.1 <br /> n <br /> n 5-_ Transporter 1 Company Noma b. US EPA ID Number C. SlwoTra+'sporta's ID IRaserved.J <br /> �f. �'i^�+ s'►-'/mUS t_r� Su v If-C P1 4 0 0 3 9 3 2 2 1 S D, Tran$jotter'$Pfsone <br /> C> C)st <br /> ba) 8S 11 <br /> O <br /> T 7. Transporter 2 Company Nome S. VS EPA ID Number E Slots In:sm ps Aer's ID Resrrved.J <br /> F. Transports!s Phone <br /> rU 9. Deiignoted Facility Name and Site Address 10. US EPA ID Number G. StofehaciGtl/s iD <br /> Cj,,EAN 44JZBCA5 ysN jjost <br /> �Z I d1� ��Rf�`IESSq 3LuO K. Fac TN's Phone <br /> SAN 3--SaeG4 45>33 d 9 Iqq I [ yO$I 'qS SDo <br /> Q� 12. C. i­'. I T7.Told 14, Unit <br /> I 11. US DOT Description(imludittg Props Shipping Norne,Hazard Class,and ID Number) <br /> No. Type i Ouonsity Wf/Vol I. Waste Namber <br /> Jz , c.-tasr� Soprv �t0�xlo� �o`�reo t Sr Mate <br /> t2I- <br /> �_ / �g�tt P(�tS i0 19 r CPA/Other <br /> R l52 c9a� O i % C'7 p <br /> o N b. state <br /> `pm E <br /> c R EPA/O f.r <br /> Q A a State <br /> a T <br /> 0 <br /> IF <br /> r R EPA/014e, <br /> ce d <br /> State <br /> Z 2 <br /> V EPA/Oihar <br /> w <br /> V J. Addificreal Descriptions for Materials 40ed Above - �� K. Hondfng Codes far Wastes Listed Abose _ <br /> o ria) cµ).i23q8 a- <br /> Uj <br /> CY- t. cl <br /> Q <br /> Z 15. Special Handling Inslructionsond Additional Informolion <br /> o L_jt--4�a p Ac)Pc`i2 PPS,-,qi-e-4 r4.F.10L4*,4E; <br /> aI ,9. �g�lSf'► I" C46t c4LL!R00, q3' 3�Ig <br /> 14-t LU <br /> r <br /> 114- <br /> t <br /> 1 6. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this wnsignmutt o-&fully and accurately described above byprciper shippirsg name and are clossified,packed, <br /> Q marked,and lobeled,and are in all respects in proper condition for transport 4'highway accordirsg fo applicable inlerrwtiund and nafionol govern—rif egul.lico s. <br /> U <br /> j_ If I am a large uanti meralor,I cerci that I have o prtom in lace to reduce the volume cod toxicity of waste nerated to fha de ee I have datermined to be economicoll <br /> 8 9 -fy g fy P ag P lY 9e 3r h <br /> 6- proeficabk and that I have selected the rociicable method o rreatnent,storage,a disposal currently availobk to me which nin�rnizn the present axd future threat ro human Iwolrh <br /> V) and the amvirornten f;OR,if I am o$moil quantity generotor,I have—d.a good faith:affil to minimi—my wat'e govt—xion anu select the best waste maroge—N method fbof is <br /> available to me and]hat I can afford. <br /> d <br /> } Prin(wf/Ty d ame Signa Marti, at, Year <br /> V <br /> Z <br /> 0 T 17- Tran otter 1 Acknowle etnenf of Rece' I o Materials <br /> itW #A Pri-Nd/Type Nome Sig re - Morrill, Day Year <br /> R _ <br /> If ham, feuIf 10 1 eA2 VZEC7 '/ <br /> � 0 18- Tr—porter 2 Acknowled ement of Receipt of Materials <br /> R Printed/Typed Name I Signature Mantis Day Year <br /> T <br /> w E � t � <br /> N R <br /> a <br /> U <br /> 19. Discrepancy Inditarion$puce <br /> Z F <br /> — A <br /> C <br /> I <br /> L <br /> I 20. facilityOwner or O erotor Certification of receivt of hazardous malerids cover, tlsis manifest exec t as noted in Item 1 <br /> T p�/TYpad Name Signal a Month Day Year <br /> Y - g"1 C) U <br /> DO NOT WRITE BELOW THIS LINE. <br /> (I/99} 'rite- TSS: SU-2�ThiS i TQ UTC <br /> DISC 8C22A. •'•"ir1iN 3:: DAYS. <br /> EPA B7C22A To: P-p, Box 3"0' Sxrumanra, CA 956'2 <br />