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.ur trio-Er, m�mn Yr..i�cnar A�encr , See Instructions on Oack of % 6 I r`r "
<br /> r, , AGntB No 2054-0039 IE,pires 4 30 43, t Dep artrent v ter,c cru la
<br /> U J.r , r type Form designed!o, vsa an elle(12-p,tch)type-roe+ _- T_- � aacramenro Cuhf�rnio N
<br /> I Generolor s US :AF ID No Manifest Docu"ent No 2 Paye 1 Infonna ion in rh ,hadrd areas
<br /> { I UNIFORM HAZARDOUS is not reguirei by Federr'late
<br /> WASTE MANIFEST
<br /> 3 Gcneralor s Noma and Marling Address F Stogie Manifest Document Nur l}er � I
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<br /> ID71
<br /> fV 4 Generator's Phone (s s') r��i! rJ { t1, a `~- w_
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<br /> 5 Transporter I Compony Nome
<br /> h US EPA ID Number C, $T�e T+afuparl s{L1 J +s r'i aW
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<br /> < 10 US EPA M Numbe G
<br /> 9 Designoted Facility Name and Site Address t t�• ti s
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<br />�J 12 f Conimi-ows T 15 Total ld Umrt`
<br /> a 11 US DOT Dascoption(including Proper Shipping Name Hazard Class and ID Number] No T e Quantsly Wrryol f 1Ycs4e t3arts t.
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<br /> _ , F {�,HOndlln4 Codas la�Wastes 1.ssted Abate
<br /> ` 3 Addihonat Desenptiar»Fon Atlaterrrats fated Above �{,- "y, c , b 7 r
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<br /> O � I 15 5peuai Handl,ng 1nsLudsons and Additional 4sformalion
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<br /> highway according to applicable international and national ge+errmero regulations
<br /> 16 GENERATOR'S CE ed
<br /> I hereby declare that the co ile tits of this consignment are fully and ac�urakely des%r,bed above by proper shipping^dine and are classified
<br /> -s I packed mucked and label and are rn all recpmds in proper candrtran for
<br /> transport:^y 9 Y
<br /> deitirmuied
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<br /> of waste
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<br /> J l am a large quantity generator I ceri,f,, tn°t 1 have a program m placetrteQtmentesscrogelFe lLoredisposal}currently available etotma twh ch mem ze- the epresent end liar re
<br /> If 1 9 gwaste eneraiion and soled the bc•t
<br /> economically practicable and that I have e[E<'ed she practicable method of
<br /> n threat to human health and the envvonrent OR ,f I an, a small quantity generator I hoes mode �gaod faith effort to minimize m 5 Day Yoar
<br /> waste mano�emerot method that s available'fable t°�-and sl at 4 can a'ford -Y Y y r onth
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<br /> U 17 Transporter 1 Acknowledgement of Receipt of Materias
<br /> I Signature ���
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<br /> 1 0 18 Trom orier 2 AcknowLU Pleaocmeni of RecP /a( Motenal5 Signature I r I !
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