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ate of California—Environmental Protection Agency <br /> arm Approved OMB�No.2050-0039(Expires 9-30-99 See Instructions on back of Pt`^s! 6. Department of Toxic Substances Control <br /> , <br /> lease print or type. ooq designed for use on elite 112 pitch)in r. Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST <br /> OF ' <br /> 3. Generator's Name and Mailing Address 1' A. State Manifest Document Number LI ry`p 52 <br /> O P P + B. Stale Generator's ID <br /> V) 4. Generator's Phone <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> h <br /> O D. Transporter's Phone <br /> OP 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] <br /> I~ F. Transporter's Phone <br /> .�V 9...Designated FacilityNartle and SiteAddres., 10. US EPA ID Number G. Stote�F,ocil(ty,�ID-. •� <br /> � ;:�. ,err r•t;4 1"f?; ;' �, ;, H. Facility's Phone <br /> 16 <br /> Q 12. Containers 13. Total 14. Unit <br /> V 11. US DOT Description(including Proper Ski ping Name,Hazard Class,and ID Number] No. Type Quantity Wt/Vol I. Waste Number <br /> Z a, State `3 <br /> ~ G EPA/Other <br /> 3 t. <br /> O N b' State <br /> opoE <br /> 4 R EPA/Other <br /> v A c State <br /> o T <br /> a0o O <br /> R EPA/Other <br /> ix <br /> Uj d. <br /> State <br /> Z <br /> LU <br /> V EPA/Other <br /> w <br /> to J. Additional Descriptions for Materials Listed Bove K. Handling Codes for Wastes Listed Above <br /> a J. : <br /> w <br /> C. d. <br /> J <br /> .1.5.,SpeSia�Handling Instructions and Additional Information <br /> t ( t y� <br /> Q F_ ..I P,: 1V' -i : <br />