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State of Cakfami mt4anmemW Protection Agency <br /> Form Approved OM.B Ne.2050-0=9(Expires 9-30.94) See Instructions On back of page 6. Department oI Toxi substances Central <br /> Please polt or HPe. Farm dnigrred for use on elite(12pech)lyes wMer. <br /> Sac.amema,California <br /> UNIFORM HAZARDOUS 1. Generators US EPA ID No. Manifest D«umenl No. 2. Page 1 1,formafion in the shaded areas <br /> is net required by Federal law. <br /> WASTE MANIFEST C Q 1912- 9 —7 of 1 — <br /> 3. Generator's Name and Mailing Address <br /> 4. Generators Phone 040q 23 6 <br /> 6 <br /> 0 5. Transporter 1 Company Name 6. US EPA ID Number tat D <br /> Drama RQso��e Cay iD10170101814-31 Q- <br /> 7. Transporter 2 Company Name B. US EPA ID NumberD <br /> 9. Desi cited Facility amu and See Address 10. US EPA ID Number G' <br /> Dry � colzP- . <br /> oar <br /> f <br /> I1. US DOT Description(including Pro Shipping Name,Hazard Class,and ID Number) 12. Comainers 73. Tocol 14. Unu - <br /> J 1 ,P G^c 9 per PPi^9 No. T Wan Wf/Vol ,n- asle;Numbe_! <br /> t: a oi�Zce�e@oAS WaS 5Dlid �5IIJeT <br /> E -�' ` N1�ILS�i e // � ,^� I 0 O l P P .fir <br /> m E b. I�a�o r4S �oAk 50 U d off-) is s��J tate" <br /> A o - lIt`)M'f51 0ATO <br /> T e ate. <br /> o <br /> w <br /> R <br /> P <br /> Zvia 01M <br /> w a <br /> N <br /> O <br /> W <br /> Z # <br /> Q 15. Spec al Handling Inzt o z and AddBanalInform n <br /> PI <br /> Weems �t-1 ,)es �^^ n �%o <br /> w <br /> H <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described obow by proper shipping name and are classified, <br /> Qpacked,marked,and labeled,and are in all respects in proper condition f«Transport by highway according to applicable federal,state and inlemationel laws. <br /> U <br /> If I am a large quantity generator, I certify that I have a program in place to reduce the wlume and toxicity of waste generated to the degree 1 hove determined to be <br /> J eco anically practicable and that 1 hove selected the practicable method of treatment,sforbge,or disposal currently awilable to me which minimizes the present and future <br /> ydj Threat to human health and the environment;OR,'d I am a..If quantify enemar, I have made a good faith effort b minimize my waste generation and select the best <br /> waste mono emenl method that is awilable to me and that I can afford. <br /> Q Primed yRed me_ Signora - MOMh Dry ^Year <br /> I l/t o ( h <br /> Z T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> wPrince Ty,d Namq Signature ©o^ ODay Year <br /> 0 18. Transporter 2 Acknowled emeM of Receipt of Materials <br /> w T Printed/Typed Name Signature Month Day Year <br /> 0 r <br /> Q e <br /> w 19. Discrepancy Indication Space <br /> N <br /> U F <br /> U p <br /> Z C <br /> I <br /> L <br /> 20. FacilityOwner or Operator Certification of recei t of hazardous materials covered this manifest except as noted in hem 19. <br /> T Primed/Typed Name Signature AbMh DoY Year <br /> r <br /> �J S z o <br /> DO NOT WRITE B LOW HIS U E. <br /> BY <br /> LOW <br /> 8=2A ] Why/ TSDf SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> ( /97) T3� P.O. Box 3000, Sacramento, CA 95812 <br /> EPA 8700-22 <br />