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Mar 10 05 03: 59p p. 3 <br /> State of Colilarnio—Environmental Protection Agency <br /> form Approved OMB No.20504039(Expires 9.30-991 See Instructions on back of page 6, Ooporiment of Toxic Substances Contre <br /> Please print or type. Form designed for vse an*file(12•pikh)typew war. Sacramento,California <br /> UNIFORM HAZARDOliS 1. Generate',US a, Manifest Document No. 2. Pose T Wortnation in the shaded areas <br /> is nor required by Federal law. <br /> WASTE MANIFEST C d R q 1112 3 $ 4 L4 3 of 1 <br /> 3, Generators Nome and Moiling Address At( <br /> t(N—4 A_ State Manifest Document 14-6.,r <br /> z s. c4-4.i coR,viq R,0 S4�CK j C4 23638443 <br /> O C1�,��/ B. Slate Generobr's 0 <br /> H d, Generator's Phone{ZotI ( b!413-J t--tSQ i <br /> t\ <br /> N S. Transporter I Company Name 6. lis EPA 10 Number C. State Transportar's ID jReserved.] <br /> un <br /> O CL.�A.4 r" OA—s 1� p Q 4 D. Transporters Phone <br /> TMJ A 3 R 3 'L '3..� tG CW-1-1 -S(P 2� <br /> 0° 7. Transporter 2 Company Name S. US EPA ID Number f. Stale Transporters ID Reserved.) <br /> J <br /> MJQ F. Transporter`,Phone <br /> �v 9. Designated facility Nome and Site Address 10. US EPA iD Number G. State Facility's ID <br /> te-�tA1L�.+L)-�C+Fi$� �J^4'�•'� <br /> 00ce t(7� '7�+'`1'�ye-e� +�'J H. FociiiVs Phare -I f <br /> �c-00 s v ��.co 95►33 c 9t�iq r C4jov) L4, I� m� <br /> W Q <br /> 11. US DOT Desai Iron includin Pro Shi n Nome,Hazard Class,and ID Nambar 12- Confainers 13, Total 16. Unit <br /> MU P" !' g Pet PPi g I <br /> No, Type Ouanfity wrNol 1.Wada Nunkwr <br /> CV= a.p41r o4[u t4�t O>ctqeS -vttp^J1S,vNr9z4 sbti j 2Z <br /> -y <br /> 3 E ;d�oz E O D M o 3 C) EPA/Otl..t)00'Z <br /> o N b tCAO t�V Lt+Q"tl�,nt 5 p �acesuj j state . <br /> m E <br /> CV A ( � d d ! �7 fPAJot 2 <br /> o T e n10 - t P-4-5-1-Q)Le u+ f sta,a 3 3/ <br /> - R CFL i7(�R!/sr.O-XJ n EPAIOtIwr <br /> R '1 <br /> Zz d. N4 4EfiP�tSM/� ROc?vs w tNi t Stale 3�� <br /> CPPB <br /> U <br /> , O {7 EPA/Ofbe" <br /> w J. Additanal Descriptions For Materials listed Above (` <br /> O F t A C^`+—L- r/rL'33gv X fs1O►y K Flandlurg Codes For Wastes Listed Abore�,c-, �s <br /> 1cl�C�sJ7 l+ 1 x J�� OC a t�� �o b" r`5 ll t —V3 <br /> ^} f <br /> C. <br /> d <br /> Ct <br /> O 15. 5peca edling Inslructians and Additional Information t�1&4A Pp_F&A Apt wlt� J.{-�PLIIV� "��-s rte+, th( �$l- c 1~ <br /> a raOFpF✓CS?-NS(fr&eC,t.rrse0y c%+cY� <br /> z )1 1 f <br /> IIA-) 1 Jrq 1S'[j rlC �lIQ fg <br /> 16. GENERATOR'S CERTUXATION: I hereby dedore that the contents of psis consi nment era Full and atcuretel de—ab-A above o proper tri f' <br /> Q $ Y yy y P P* ppmg rsoma and are classi.red,packed, <br /> u mar4ed,and labeled,and era in all respects in proper coedit:ox for trompod by high.vay accard'mg!o appli<abfe international and national gavermmenl regslafions. <br /> —'' if I am a large quantity genemfcr,I certify that 1 hove a program in place so reduce the volume and toxicity of vast-generated to the 41-91**1 hove determined J.be*canonically <br /> m <br /> N pro<ticabte and t6at i have selected the prodicoble rtsdhod of treatment,sloroge,or disposal cwren!fy oyoiloble to a which mfuture threat the prasenI and futthreat to human 6edth <br /> and the erwironreenl;OR,if I am a small quoatify senerabr,i hove modea good faith effort to minimize my worse generafioo and select Its*best+rife Management method Ihor is <br /> O <br /> avora6le to me oed that t ran afford. <br /> y. Printed/Typed Name Sgna Manth Day Year <br /> U <br /> Bort rj k r`3 ZQ <br /> w <br /> B 17. 7ransoorter i Ac +e <br /> wled ant of R<cei tat Mls <br /> ateria <br /> cc 11 Prmkd/Typed Nome Sgnafur s s Month Oo Year <br /> X Y <br /> 2 <br /> w P 0 <br /> - 0 18. Traasoorter 2 Atknowledaement of Reccint of Materials <br /> R <br /> Printed/Typed NameLU I $gnoture Month I Day Year <br /> Q R <br /> u 19, Dlserepancy Indication Space <br /> Z F <br /> - A <br /> C <br /> I <br /> L <br /> 20. Fac;4ty Owner a Operator Cenificalion of recei i of hozordous malerlols cover this ranifast e:.ce roc noted in Item 19. <br /> T hd/Typed Name Sigr alar* <br /> ) Month Day Vear <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/991 711--'r ;ci=.U:; T;!:S i'J :JT-.'! d C''r,t5. <br /> EPA 8700-22 ia. T.O. Bo,. 3000, Socramenfo, CA 95352 <br />