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Stare of Californlo—Emwonmentol Prarezflon Agency f <br /> Farm Approved OMB No.2050-0079(Expires 930-94) See Instructions on back of page 6. Depadmem of Taxi S.Winces Control <br /> Please print or type. Fcz,o designed for use on efire(12pitch)typewriter. sec•ammto,California <br /> UNIFORM HAZARDOUS I. Generator's US EPA ID No. Manifest Document No. 2 Page I Information in Me shaded.,.as <br /> WASTE MANIFEST %A / j n(/ is not required by Federal law. — <br /> 0. Generator's Nome and Moiling Address 0A/E.X "' tete adest 'mbiy_ a' . <br /> O <br /> us,ul C7, �G / S-C �x.l�lls/K'Jn/ k C. ; Oxy D <br /> n n/-! - <br /> `B:AsfaletGerierato'Ts10 <br /> h d. G<verator's Phone <br /> O5, Transporter 1 Company Name 6. US EPA ID Number <br /> —1 k� .SO )IG Ce� E--F--/ 164 2 / ( <br /> 7. Transporter 2 Company Name B. US EPA ID Number S{'ale ransporjeZs7D z <br /> -'ll a1 <br /> r rte? <br /> 9. Design aled.FF 'liry Nome and See Address 10. US EPA ID Number `}anldsyS.{D d <br /> DKELJ �Scv2CF <br /> - 7/0 C NI . r <br /> J1 12 Co r me 15. Total I4. Unn <br /> 11. US DOT Description(including Proper Shipping Nome, Hazard Class,and ID Number) <br /> No Tse O nY Wt/Vol ast<, , <br /> ° f1Afo2a;•(�,�5 (ca5` i C So%L7 �7 1st <br /> E � � Eaaale <br /> z <br /> 00 N b. <br /> m E p <br /> R EPA quer: s <br /> d A <br /> O T C. tSf'dte <br /> 00 O <br /> R <br /> w *- <br /> ~ d. Sfak <br /> U <br /> w <br /> N <br /> Z <br /> 0 <br /> N <br /> W <br /> tY <br /> Z <br /> Z <br /> Q 15. Special Handling Instructions and Additional Informatyi ^ , <br /> Z <br /> ! ^ Jc��l i^�L� C7�V✓r <br /> z <br /> At — <br /> =/tel / -.�-,_- �,✓t% ti//� - <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that t4,caselecits of the nsignmenr are fully and accurately described above by proper shipping name and are classified, <br /> Qpacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international lows. <br /> U <br /> If I am a large quantity generator, 1 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 Me present and future <br /> u') threat to human health and rhe enviromment; OR, if I am a small quantity enerator. I have made a good faith effort to minimize my waste generation and select the best <br /> wa to mance a ent "ethod that is available to and that I can afford. <br /> Q Primed y ed a <br /> Signors; Month Day year <br /> I � <br /> �� ` Q t 1 <br /> Z 1 17. Transporter I Acknowled ement of Receipt of Materials <br /> W B <br /> U• A yped Name l Signa Month Day or <br /> W e <br /> 0 1 B. Trans orter 2 Acknowled a em of Receipt of Materials <br /> w I Printed/Typed Nome SignaNr< Month Day year <br /> E <br /> Q e <br /> W 19. Diureponcy Indication Space <br /> N <br /> Q F <br /> UI A <br /> ZC <br /> — 1 <br /> L <br /> 1 20. Facility Owner or Operator CertiBcolion of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed iYP(ed�Name Signature Monts Day Yen' <br /> DO NOT WRITE EL T IS LINE. , JJ <br /> Whne_ISDf $EnE'S i OF,. 'O DTSC WITHIN 7(: <br /> DISC 8022A (7/92) To PO Be. -,k" __�..�mentn CA 9581- <br />