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Oct 14 04 11 : 29a Jure Huber 209-q68-3880 p. 2
<br /> 'r state of California—ERvimnrpental Protection Agency %00
<br /> r FOrtn App rQRM16 Na-4050-9034{E1.30•Q91 , See Instructions on back O age b• Di partmSa of lento Sub*faeces Cc
<br /> P prtnt or IM. F6trn dosigne�d FDP% ' an hire(12-pikh)rypnwritor, Sacrament •California
<br /> Iw Generalor's US EPA ID No. Monifesr D—vmenl No. 2. Page 1 Inf. marion in the shade)e.reas
<br /> UNIFORM HAZARDOUS a n 31 requited by fedora[law
<br /> WASTt,,MANirEST
<br /> 3, Gane,Vlor's Name and tALOin Address A. Slate MVniEesi Document Nvm[ r
<br /> Mss "1 8. Srate GnMroro/s ID
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<br /> Gonororor's Icon•IQ c
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<br /> sv 5. Irms,xNter 1 Company Nome tl 6, U EPA ID Number• C. Score Tran;peHer's ID[Re+ery
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<br /> m °. US EPA ID Number E, Store Tran5por,er's EP[Reserve
<br /> 7, Transporter•!Company Nama
<br /> F. T,o•,stwr1or'5 More
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<br /> 10. U5 FPA ID Number
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<br /> l..�+�1� ff0a��r !i.•Facilisl;�s P[1on4 ftiL'I✓tti;A:��(, C11' 3G7 C A �}� �} Q 3 � Cr I $ Liftt-Ea+i3�a;�1
<br /> Q 17. Conlai ne us 13 Total 1 Unit -
<br /> ^` t 1. U5 POT Dswc iplian 6neluding Proper 56ipping Nome,Hazaftl Class+and ID Nvmbrrl Na T �uan"ry I/V-1 I. Wvsre Nomba*
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<br /> Z CPA/Other
<br /> s++ K. Handlin(t Codes[or Wasles(i ted Above
<br /> Z1. Addltloaal P.scrlptiona,for marwiol*Usted Above b
<br /> MY,WATCEi
<br /> 0 15, Special Hond[ing to tlrvGtions and Addihonol Wormo,ion
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<br /> z LMEHOONOY P110NIr 2M- 67•MS7
<br /> 16, GENERATOR'S CFYTIRCATION: I hereby declare that the contents of this�ons�'gnmam ora Fully and accurately described above by proper ship ino na and an.rlotidi ad,pocked,
<br /> Vnarked,and la[seled,and are in all rmpmh in proper condition far honsFort by higf way accardln0 to app[iw6le inwepotiono[and national govern ni rogvlaliun>.
<br /> II loon q large quantity peaeroror,i certify that I hove a p ram in,place fo reduce the volume anti loeicity OF waste gtnorotad to the deoiee I hn dawrminad to be sconomicalfy
<br /> o Practicable and That I S ave select d the procti;abls method of IreOtmont,storage,or dispaeol currently avoiloble 10 me which mini nixM the premnt and 1u1w9 threat ro human has,lu
<br /> s� and the anrironment;OR,if I am a,mall gvontiry ypnervton;'1'haw'mode o good fcA effort to minimize my wasts generation and select the[sort sro managamenl method the is
<br /> ovniloble to me and 16ar 1 eon afford.
<br /> 0} Prin /T7p.d Nam. Signature /I +'�' .».... Month Pay YL
<br /> LU T •17. Trurtbpoewr I Acknowled emew of Roca l I of Mat@604 .. -
<br /> w j Printed/Typed N •� ! t Siynatvr� Month vay Yac
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<br /> 18, Trans rte*2 Ackeowled .mint of R.cei I of Materials l __
<br /> 0 1 Prinled/Typed Name Signature /, h1onlF Day Y.
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<br /> V 19, Cnscrepancy Indicorian Span
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<br /> E 20. Faclli Owne;,;7; ata.CertiReation o4 recti t of haxordout eto,erial.envered eFi:mans est t as noted in Item 19.
<br /> T Printed/Typed. Signature Month Cloy Yr.
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<br /> DO NOT wirra BELOW THIS LINE.
<br /> DY$C 8°22A (1/99[
<br /> EPA 8700-22 C.ira:u I'riAIVSt'(JKILh tic Ir.
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