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12/16/03 17:25 NORTH'^`< FRENCH CAMP 4 2094683433 NO.214 P02 <br /> lots of Cgliforaia—Env;renr�tenra}ProwliciA ency <br /> arm App"J OMG Pa.2050-0034(Expire, •30.99) See Instructions on back of� ,,,6. Dcpariment of Taxis Substances Cenrrol <br /> lease pr; far type. Form designed for use on elite 112•pilch)typewriter. Sacramonln,California <br /> UNIFORM HAZARD V$ I. Generator's US EPA ID No, Manifest Pacumant.No. 2. Pogo 1 [!tntnv%,,a6on fn the shaded araasWASTE MANIFES of a by Federal low. <br /> 101k <br /> ffm <br /> : 'dnervfo"Name and Mailing dress »'�'"" A. State Manifest Document Number <br /> t / s�� <br /> 99897498 <br /> S..S ate Generator's ID <br /> 4. Geoerotor's lihans1 �►p rte <br /> ' j S. Transporter I Cam pany Noma ;ryg� b. U EPA 10 Numleor C, State Transporter'&ID Reserved.) <br /> LY�-'S �AiFi� DTronspaftof'f f'�Iona <br /> OM <br /> C1 Al 0 <br /> i100 <br /> 7.Transporter 2Compony Nomo 6. US EPA ID Number E, State Traneporler's ID IRotorwd,} <br /> W I I I I I I IF, Tronsparfer's phone <br /> !� 9. p i F m d Sir Address 10. US EPA ID Number - G. State Foci itl/s ID <br /> gaest aZltTtliC! � H. Fddlily's Phone <br /> 0 ���� 91. t� 8T48 (fit)70341110 <br /> 12. Co liters 1 13. Tota) 14. Unit > <br /> '11. US DOT Description(induding P per Shipping Nome,Hcaord Class,end 10 Num6ar) <br /> No. Tye Qvanlily Wt/Vol I.Waste Number <br /> I r Oil yRT¢. Stele <br /> G 11GYRI-ILiA1/� Rv ryOvi � jf 1 EPA/" <br /> lhp <br /> 1 61011 <br /> E j b, $rate <br /> N <br /> E <br /> R EPA/Olher <br /> A c. $late f <br /> T <br /> 0 <br /> EPA/Other <br /> �I <br /> d. Stole <br /> EDA/Other <br /> I <br /> I <br /> iJ AddNmol Descriptions for Material listed Above K. Handling.Codas far Wastes Listed Above <br /> Q b. <br /> i <br /> 115, Special Handling Instructions and dditional Information <br /> E+tOia CM 1'8*4X- "Raw 41,7:rs?yFl, <br /> DOT Ma ill MWIVEMMM' <br /> i <br /> 16. GENERAT011116 CERrIFItAincl � I aroby declare that the contenh of IkII conslgnMntore fully and omrclety described obova by proper shipping name and oro classified,pocked, <br /> I marked,and Iobeledr and are in a I,.:pees in proper condition for trpoepor+ y highway occoiding to applicable international and notional government regulations. <br /> y <br /> If I am a large quantity generoror,I certify that I have a prog?om in place,m reduce the volume and loxiciy of wpeis generated la the degroo I have dorarminod to 6c oconamica11r <br /> practicable and shot I have solacra rha procfica6lo moil od of traotmtlnt,slaroge,or disposal turrendy available to mo which minimizes aha present and future threaI to human heollh <br /> end the en•iwnmeM;QR,if I am +mall quantity generator,I have mode a good Faith effort to minimize my wosre generation and select the best waste management melhod That is <br /> { available to me and that I con affo <br /> j 'Pr ped Name Sigel r. Month t7oy Year <br /> 1 fi 7 Trans otter 1 Acknasv( ement or 0 ariptolmoterTak <br /> t pint d/Typed me tNonl ��W Y <br /> a g, Trons rler !Acknowled omant of ace/ f.(Materials <br /> i 'Printed/Typed Name Signalers roweth Day Year <br /> E <br /> R <br /> 19. Discrepancy lndieolion Space <br /> i Ci » <br /> i f _ <br /> } I 20. Facility Owndi oro orator Certific ion of u..i f of hazardous motoriols'covoiod hy Ihts manifest except as noted in Item 19. <br /> I T IPrintod/Typod Name Signature Month Day Year <br /> 11 r j <br /> DO NOT WRITE BELOW THIS LINE. <br /> D75C 8022A(1/99) Yr,Ilow VE.;ERATOR 3E'AINS <br /> f EPA 870Q-22 <br />