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State of Cohlornio—En—cm-enrol Protection Agency r <br /> Form Approved OMB No.2050-0039(Expires 9309A) See Instructions on back of page b. Department of love Subs. <br /> Please print:.1". Form designed To,me on ehre(12,1,hl «.am <br /> 7Pewrirer. 5emo.Calilo o Can,,., <br /> UNIFORM HAZARDOUS 1, Generator's US EPA ID No Manifest Document No 2. Page I Information it the shaded areas <br /> WASTE MANIFEST r.C Vs rat required by Federal law <br /> C <br /> 3. Generator's Name and Mailing Address <br /> O CtA/r_K A. Stat N,ani(est Oocummf Numbs( - <br /> (� 923192501 <br /> n S-S i%'Fcf u S Jc'r.'�/ "7-/< /''14/✓7`f'!'c� C c"C ��I"J:! _ <br /> R stain(xneralor s ID <br /> hd. Generator's Phone s.G� ) <br /> ca T <br /> 00' 5. Transporter 1 Company Nome b. US EPA ID Number C.'Srot T lupbnds ID //Q/ q� <br /> m / <br /> D. icanspaner,'s Phone 5/0 342 ;` OU <br /> 7. Transporter 2 Company Name B. US EPA ID Number E.51ate Transpdnar's ID <br /> U <br /> Q F.Transport r'e Phone -- <br /> Z 9. Designated Facility Name and Site Address 10, US EPA ID Number G Stale Facility',ID'. - <br /> /'GLtI /�ztfCil�i/C'f' CG <br /> H Fadlty's Ph,_, <br /> U <br /> 0 -,F - 210 U <br /> Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12, Container 13. Total la Urn <br /> No. Type Quantity "/vol I. Waste Number <br /> 2 <br /> 7`C .YJ 2e <br /> G <br /> o E J• /vat oc�k -v <br /> b. <br /> C9'itE Iy�2<yc�Fl Ce f �.JQTS"1`e �: <br />