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blare at Z-7- ency <br /> oli --- <br /> Fn Approved OMB No 2050-0039(Es:pfrasl 30 99) See Instructions on back of page 6 r Depoomenl of ToxicSu6stonees Control <br /> Please print or type fours deslerted ler use oe efde f 12 prrchJ ypevrdter Sacrargento,Galfrarere <br /> UNIFORM HAZARDOUSGenerators US EPA ID No mantfesr Dowrnanl No 2 Pogt 1 Infarmallon In the tI&aded 7r—gas' <br /> 1s net required by Federal(oar <br /> �Ihip <br /> WASTE MANIFEST q � Jt' S 3 14 1b � of <br /> 3 CGenerators Name and Moiling Address v <br /> JCJIr �crv�c.( CdRp 2335 rrAq10� <br /> SgGR M u-Ta -A• <br /> 4 Generator s P one f e, I W t <br /> cy S Transporter I Company Name 6 US A Number <br /> �CO�Ow CONTROL INDUSTR12S A D ® 8 2 Q 3 01 7 3 <br /> O <br /> 0 <br /> 7 Tran.porlar 2 Company Nar++t A US EPA ID Nfyptber <br /> qsll <br /> J 1 <br /> 1 ' <br /> U Ev tRtC"0NR11;I®me and Stle Addras 10 US EPA ID Number <br /> Q <br /> 25S PARR BLVD <br /> r o RiCHWIOND• CA 94800 C q 0 9 4 6 6 3 9 2 <br /> escnphon I+�duding Proper Shipping Name Hazard Closs,andD INumbed 12 Conlomen 13 Total le tJn <br /> 4 11 US DOT Dls <br /> V No T Otmnu Y/rlval um <br /> Z WASTE EMPIFY S I Of <br /> ,; Non-RCRA hazardous waste solid TP P <br /> E Dat Zdao P' Ior <br /> jxS, <br /> e R tar r dt , <br /> c A s <br /> o T ` Shale <br /> m O <br /> R SPA/QlEter <br /> y i <br /> LU d Simi <br /> Z ' <br /> V EPA/other <br /> � I <br /> ZJ Ad¢1)lanal Ducrlptlons for Material*�Fsrp t fter' r I< }iandLnQ 1 raboYP, r & <br /> 2 QTY ' MFPTY STO L y y> <br /> 15 LOO DRY ICE: PER 1000 G4� A l 1 <br /> 'FP�dr C h ' s$elf l &fit � WTI' j� '! � raI <br /> 0 1 p n Ing. <br /> 24 Hour Emergency Telephone Number: <br /> W 24 Hour Emergency Contact: ERG 171 <br /> r 1 d GENERATOR'S [ERTIFICATI I hereby declare that Ifie coolants of+f s const nrlsens oro h,1y and a<eurolelyy daeeribed abo•s by proper ship <br /> pmg game and arc cla.sified packed <br /> Q marked and labeled and are to all rospecis in proper c"Ohlon Far transpare�y high—ay according io applicable+ntemaponaf bpd national government re3ularrans <br /> V <br /> If I am a largo quanig rjeneramr I certify that r have a program to place Io reduce Ike,volume and ioziclly of-ave Oemera+ed to the degree I have delerm+nad to be economically <br /> m <br /> ti prncr ole and that Iva selected the practicable method of treatment storage or dupoeaf currently available to ma ch whiminimi=es rlm present and fulury rhraal to humeri hG134h <br /> and rho onvtroMnenl,OR,4f am a small quontlly generatar I have rneda a good Forth effort ro mrnimizo my Waste eaneration and saleU the bear waste management matkod lbal is <br /> 0 available to me and chat I can afford <br /> Printed/Typed Nome SfBnarure Manih Day Yoar <br /> U-1 17 Trqnse2riier 1 Ackno-lad ameni of Recel t of Marerlals <br /> A Printed/Typed Name Slgn r Month Day Year <br /> 19 S <br /> to , <br /> 661 'Lf <br /> w a 18 Tran. lar 2 Acknowlad omanr of Ree01 of MOrerlall <br /> 0 Printed/Typad Name 5t2natura Month Day Yoar <br /> � E <br /> � n <br /> (� <br /> F 19 Dtsereponey Indleatlen Space <br /> A <br /> C <br /> f <br /> C <br /> l 20 Foal& toner or OE2ralnr Cerldiearron of rete) T cf haxordous molertals covered by this ma rfest except as noted in horn 19 <br /> T Prrnled/Typed tVameS gnntu 0 nth 6a Year <br /> y 25 � 5 <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 9027A Ia/971 While TSDF SENDS THIS COPY TO DT-5C WITHIN 30 DAYS <br /> EPA 8700-22 To P 0 Boz 3000 Sacramento C., 95612 <br />