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`5tote of(._;iforni,Emlronmemal Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-94) See Instructions on back of page 6. <br /> please print or type. Form designed for use on elite I2 rah ter, Department of Toxic Substances Can <br /> ( pr )typewr . Sacramento,California <br /> UNIFORM HAZARDOUS Generator's US EPA ID No Manifest Document No. 2. page I Information in the shaded areas <br /> WASTE MANIFEST L O �� Ci 13 C {g 3 of t is ww. <br /> t required by Federal la <br /> 3. Generator's Name and Mailing Address n ^_ A. State Manifest Decumenf Number <br /> un) 55`�1�T1, �I1G� ;w( 93639834 <br /> C4 A. Generate",Phone elr7t/4 -1601 <br /> ��` /' B. Stara Geeterabr's ID <br /> zA ✓�f -16 3 f rtt:-* f lfa . J ✓CJ <br /> O5 Transporter 1 Compo y Name 6. US EPA ID Number C. State Treur porter's ID t'n r-7¢b 7' <br /> ? _ (, rt'e (�nrpz.i L'.i I- 1011 � IDZ 3 V. Transporfer's Phone. <br /> —i 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter i ID <br /> U' <br /> F. Transporter's Phone <br /> Z9. Designated Facility Name and Site Address 10, US EPA ID Number G State Facility's ID - <br /> m Q: )rel. <br /> COO Resource C'urpora L ioll <br /> 177.7 FL)urth Street 70 843 " Farihy. hone <br /> MU - - <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers I7. Total 14. Unit <br /> M ? No. T Ouontiy Wt/Vol I. Waite Number <br /> M H=-. a. State <br /> M3 G <br /> p r <br /> -A 33077PfII? ( i1veiEPA <br /> N E DDll <br /> E P'()ZJci State <br /> CZL'v <br /> . <br /> N <br /> A. NA S I P. Cr Csrl� zD M o1oCc $ t EPA/ahQaU <br /> o TS <br /> tate D Stale <br /> d, R EPA/Other <br /> W <br /> H <br /> Z Of. State <br /> W <br /> V <br /> W EPA/Orfwr '. <br /> N <br /> Z J. Additional Descriptions for Materials listed Above K. Handling Codes for Wastes Listed Above <br /> Is. <br /> la . �.etallic Siler Compound - Chip/Flake 7' � �� r' <br /> a Iib' SP.�. -�ho{�q rrcFJk 2 5 t Th�[I- d. <br /> Z 15. Specl al Handling Instructions and Additional Information <br /> 0 <br /> L;AN'D DISpOS*_L RIPS"'R ' ("['ION INFOWN"IATION <br /> a <br /> Z - -`- _ -'' - _ • N.` � "v'. -.� ('v IC` _ �'IN' _ . . . _ 1 ! tilt)J!a '_. <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and ore classified. <br /> Qpacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> U <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 /> J 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 /> 1 threat to human health and the environment; OR, if I am a small quantity en rotor. 1 have made a good faith effort to minimize <br /> N q ty g q my waste generation and select the best <br /> waste mono ement rrod that is available to me and that I can alford. <br /> Printed Na e <br /> Q / � Signature Month Day Year <br /> t 1 e t 5M <br /> U <br /> Z T 17. Transporter 1 Asks owled ement of Receipt of Materials <br /> R <br /> W A Printed typed{ Oa Signature Month Day Year <br /> Cd a ` 46a 6��r 11 oil <br /> 0 18. Trans enter 2 Acknowled ement Recei t of Materials <br /> W r Printed/Typed Name Signature Month Day year <br /> LL E <br /> O <br /> sty 19. Discrepancy Indication Space <br /> N <br /> U F <br /> U A <br /> C <br /> Z I <br /> _ L <br /> 120 Facility Owner or Operator Certification of recei21 of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Primed(Typed Name Signatur month Doy Year <br /> Y <br /> DO NOT *Rif E, BEL)DW THIS LINE. <br /> DISC 8072A (9/90) <br /> EPA 8700-22 <br />