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F. Transporter 2 Company Name S. US EPA ID Number <br />9. Designated facility Name and Site Address 10. US EPA ID Number <br />40M I C E.",V I ROMMENI-A-1 <br />2'o81 BAY Ron C r D 0 0 9 4 51 2 8 5 7 <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) 12• Co <br />No. <br />a1 `✓tY .+ ,m. , ,..,nl`ee •ei-i •{ e_. :_.I. C�It+auy e . v.,:re i i<. G e'., 1 at <br />at —9 T <br />13. Total 1 14. Unit <br />E ( rJil 1'11 3 s (. DO1811 Q) 1 ,®rA <br />ri I b. <br />I- <br />C. <br />v <br />15. Special Handling Instructions and Additional Information := AC i L I TY <br />?t OID CONTACT WITH EVE-S/SKIN SERVICE 3TATTON <br />24 HOUR EMERGENCY f=1f-�'. NE ;<i2MBER (800) 424-9;3&4 <tr315 !�(IT-701-00 ROAD <br />FLAMMgBLE PLA`"ARD ;QEF UN1993 PROFILE # 0,1,?,+25 SI'OCKIMNN CA. 95205 <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment ave fully and accurately described above by proper shipping name andare classified, <br />packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable federal, state and international laws. <br />If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br />economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future <br />threat to human health and the environment; OR, if I am c srrall gt,antity generator, ; have m^de a good faith effort to minimize my waste gerera".or, and select the best <br />waste management method that is available to me and that I can afford. <br />Printed/Typed Name Segnahr4e / ;];V FjE.,�!€9LF C3' Day Year <br />:1 t_ , <br />of <br />Printed/Typed Name <br />19. Discrepancy Indication Space <br />ZU. taco owner or <br />Printed/Typed Name <br />2047524280+3 41r? . <br />3022A (12/91) <br />`00-22 <br />J <br />Month Day Year <br />aegrnnure MortNt Day Year <br />1 <br />irdous materials covered by this manifest except as noted in Item 19. <br />Signature Month Day Year <br />DO NOT WRITE BELOW THIS LINE. <br />Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />To: P.O. Box 400, Sacramento, CA 95812-0400 <br />0 <br />