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JUL--26-2004 MON 10:34 AF <br />Swiss .1 Colifenia—Envinennupwall protection Agency <br />Fwm Approed Wilt No. 205D-0039 lExpiroo 9-30-79) <br />Ri <br />P. 02 <br />See Inistruclions on back of plie Department of Toxic Substances Control <br />Sacramento, California <br />I 1 0 7 * 114114kil'i'Millil <br />DYSC 8022A (1/99) yelta,.: GENERA70R RETAINS <br />EPA 8700-22 <br />Informal n in the shaded areas <br />Cwwwiia�r's US ID No, m i Oost Document N- 2. Poet I lnot required by Fedora) IV- <br />U14FORM HAZARDOUS <br />WASTEMAM11' <br />,VT re L t <br />711 '07711'" 'i�' <br />It Meiling d"866 <br />�.sullw¢ <br />f <br />A. 6.11., Miens, 153 of U `73 0 r7rl 4) <br />6. US EPA ID Number <br />is <br />it's <br />S. Yrarspersor I Company Nam <br />Amm EWRONWWALSERVICES <br />of <br />7 Transporter 2 Company N— a US EPA 111. <br />9- Des' d F -I- N ad Site Address 10, US EPA 10 N -m6#( <br />P W <br />D/K'! <br />30M EW 20714 SMUT <br />LOIS ANW.B CA <br />11. US DOT Desicriplion IMuding Proper Shipping Name, Kqxotd CIO$#, and ID Number)N®. <br />12. Gossamers 13. Total IA. Unit <br />T — - F—e. Quantity WI/Vol '11W.400,44umber yp <br />K"RA 14, NAIM, PG fil <br />"P <br />G <br />NbN RM HaVWUS WAM Ltq=. WKE WAX V -UJ <br />E <br />j9 <br />71 <br />R <br />A <br />T <br />c. <br />WN RCM HAMM "TES-OLIDPLY OMW <br />0 <br />R <br />N6N RORA WARD= WASTE LIQUD, WED OILS)'COWWTY <br />PAW <br />Aull <br />60 <br />.. ........ <br />A, <br />9a"44= <br />r <br />Iff PPE %"GEWYC4MAMCHMRW <br />11A, i3g, 1 17 1. 11 C. 171, 1 11D. 171 <br />pyo #.Lj 11 it A 15 <br />OA T5 P <br />514C is 15_1 _I t !$f'.0 fle CIO qbU31 <br />described above Is 'r-9 name to IoWfied, packed. <br />fully and accurasely and a <br />16. GENMATOR13 CIRTIFKATION: I has t' cloclore that the cooiloistl of this can y proper <br />to International and 011=1wretent ragulalia"3. <br />JC <br />tworked, and labeled, and are in .11 respect. ;q proper condition for traosportry hT."r—y according <br />applicable <br />place go reduce vim valune end toxicity of �oft Sentineled to the degree I have delswitwifted to 66 Omismicall <br />IF I am a lary quarifi gaaarow, I ca"Ify that I have, 0 <br />dispas ablo to me which minimizes flita.prowt and future throw to human al <br />=11=0 rw In <br />currently &M114 <br />love <br />too,. jaiiand sliat I selected the �rcickable storage, ew -cd <br />d �:la <br />em troom-ar; OR, ;f I am a sma quantity getweircitar, I have made a good fri� o1foet to mi jmjx& <br />is <br />my Oft* generation and select *m b -1 wofita-managament method that is <br />avaiWe to ma and the I can afford. <br />Y --7T <br />Nosed Typ.*vNistine, $r® <br />1 <br />17. Ynan nor I AcknovAndstaingel of Racelof of Materials <br />M0,06 Day year <br />I <br />LA <br />/T <br />E <br />LI <br />L6 <br />S. Transporter 2 Acknowladoemonl of "Pt of Materials <br />18. — --- -- I <br />Day <br />) a <br />I <br />Prieto/Typed Name Signature <br />19 Discrapeocy Indication Spacma <br />A <br />C <br />—20 - -foc;l;!t Owner yr at Ihlf manlFart exclgi <br />at noted in!Ie�l 9. Month Day Year <br />Priovad/yrisod Name 3ignatiee <br />Y <br />I - <br />I 1 0 7 * 114114kil'i'Millil <br />DYSC 8022A (1/99) yelta,.: GENERA70R RETAINS <br />EPA 8700-22 <br />