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ft 1 <br /> 7 W <br /> •State of Colifornid—Environmental Prdfecfi Agency, <br /> to ' ,arm Approved OMB 14o.2050-40039(Expires 9-30-94),, See InstroVions on back o ge 6, <br /> .;Phase riot or form designed/or Ute on elite 12' km <br /> . t w. em of Toxic Substances Conic <br /> P type. g ( 'P'- y Sacramento,California <br /> ators US EPA ID No. Manifest Document o 2 Page 1.]....Information in the shaded areas <br /> �JNIFORM .HARDOUS. ria r <br /> ' WASTE MA1V1 t ; :'ft r� Y �g fired by Federal law. <br /> FEST C A .161016 9 4. 0 " <br /> 3. Generator's Name and Mail'mg Address <br /> 0LwAffonoe Warmotla_ 11il1 s Wo 60 <br /> ' 7000 east Avenues, UMMIND,CA- ��¢w <br /> C4 <br /> 4. Generators Phone (510 )42 .stM. •'Aft�e A.Wot ,L-420 <br /> 0 5. Transporter 1 Company Name 6. US EPA Id Number <br /> tm Endmon, Inc `t <br /> -+ 7. Transporter 2 Company Name 8. US EPA ID Number <br /> 4 <br /> 002 <br /> .0 <br /> Q 9. Designated Focil' Name and Site Address <br /> g :tY 10. US EPA ID Number <br /> ERICK&ON It4£. <br /> moo. ' 255 Parr Blvd., RidCA 94801 <br /> 00< D 0 0 9 4 6 6 3 9 2 <br /> q <br /> sA�I�Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14.UnitNo. Type Qua Wt/Vol <br /> ~= a. <br /> Non RCRA Hazardous Wssta,Eor <br /> ol d(Empty Cftiners last Ccxltalrling ®® <br /> N E Diesel EfreQ(t�O asst kftd pong) ® '( ,p <br /> 0000 N b. ,/t <br /> 00 <br /> v E <br /> v R <br /> o A <br /> 00 T c. <br /> O - Elio= <br /> U.1 <br /> R <br /> d. <br /> wZ <br /> U <br /> LU <br /> -,; <br /> to •, , <br /> w <br /> Q <br /> Z <br /> 0 15. Special Handling instrucfionz and Additional Information <br /> EMERGENCY.CONTACT:(610)447. .:.. <br /> Z Wear prong VMP.handIhng These materials are NOT radioactively am tedUj <br /> ' <br /> HWM Requisition Numbers H135764, H135767 FOtSPout/T."Olut <br /> 16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> Vpacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international laws. <br /> ...i If I am a large quantity generator,]certify that 1 have a.program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> -' <br /> economically Procticable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> N threat to human health and the environment;OR,if I am a small quantity generator,1 have made a good forth effort to minimize my waste generation and select the best <br /> waste management method that is available tome and that 1 can afford. <br /> Q Printed/Typed Name Signature Month Dak Year <br /> >_ Richard 5 Loden on behalf of U.NL Ole <br /> Z T 17. Transporter 1 Acknowled ement of Receipt of-Materials ' <br /> w p Prins <br /> 0 td ��+�rvj p Signature Mo Y <br /> � s <br /> W P <br /> wo 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> LL T Printed/Typed Name Signature <br /> O Month Year <br /> E <br /> Day <br /> w 19. Discrepancy Indication Space <br /> Q P <br /> U A _ .. <br /> -Z <br /> I 20. Facility Owner or Orserator Certification of recei t of hazardous materials covered by this•manifest except as noted in,Item 19. <br /> T Printed yped Name Sig re . pay Year <br /> Y <br /> 31 <br /> OR <br /> QW'THIS NE. <br /> Yellow: TSDF SENDS.THIS COPY TO GENERATOR WITHIN 30 DAYS:.op <br /> ASA) +R 1 (Generators.who submit•hazardous waste for transport- -of state, r <br /> TCS+r s " produce-completed copy of this copy:and send fo'DTSC within 30.days.) <br />