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Seota of CaGlornoo--Ennronmerdal Protection Agency <br /> l,4 Form Approved CNB No 2050-0039 9 30-941 See Instructions on back of page 6 Deportmare of Toxic Sul>siortas Conoral <br /> Please yX rd or type Foran d"Wrred for u6joh Wft(12*")typewrder Sacranwdo,C456ftee <br /> UNIFORM FIAZA US 1 Generators US EPA ID No Manifest Document No 2 Pace 1 Information in the shaded areas <br /> is not required by Federal law <br /> WASTE MANIFESTirIA In 19 Ift .� of _ <br /> 3 Generator's Name and Mailing Address A. <br /> 9 " S HRVR PKTRULKUM �' ' ; ` ��� <br /> �� q a <br /> 71 <br /> In T n79fl North Preewav Suite 900, Hounton, Texas 77037 IL sIlaw, t� <br /> a <br /> Go I Generators Phone two) Itis-6?5 S eext 356 � Ir #° & <br /> ao " ' <br /> 3 Transporter 1 Company Name 6 US EPA ID Number f 151stuert <br /> '- 11 A R SHIP 4KRVTPX ;-OKPANY <br /> —j 1 <br /> j 7 Transporter 2 Co Name I3 US EPA ID Number w. YtcMtsllQrtt4a sr, 'fi' s1 <br /> Q spa Company <br /> Q 9 Designated Facility Name and Site Address 10 US EPA ID Number <br /> �ce H $ H SHr SFRVTPF +''O PANY ' i" ' <br /> �0 '16 Telry A Rranccin StiPet ,iI ` <br /> �aRan Pl anc i aro CA 441(0 E E P P ID 14 17 17 11 11 16 18 <br /> U 12 Contarsers 13 Total 14 Unit 2d " <br /> Z !l US DOT Description(mcludmI� <br /> g Proper Shipping Name am <br /> rd Class,and ID Number) No T Wt/Vol r1L L <br /> C-*J3 BIL, AND WATER <br /> G HQN-I(-RA HA$r112DOUSo WASTE LIOUTD r t � � T ,rT "31 3 Q <br /> Ef , A r 1 S <br /> 00 N b <br /> N RA x <br /> A <br /> c t1 `ta <br /> ao � <br /> �1 z <br /> a R "VIII R <br /> W <br /> Z dek <br /> " <br /> w <br /> A&Wonal DescdOlow fat'Moo"Ualed Abwmv <br /> Q <br /> 06 <br /> JIVl+4y c43 E►IAF.�, i'.�, -i » {±) } rti k { �t;u, { �„ <br /> } <br /> r <br /> t '� r , ".If'Y �� �'d �4�114. <br /> Q rtf.>�k <br /> Q15 Spacial Handling Instructions and Additional Information d <br /> a JOB 8!2242 JOB SIT?' E-Z SERA STATTON, M0966 <br /> Z 24 lir Xmproa''nry '"mitnct N A H #(415) 543-4835 2537 Waterloo Road <br /> _ APPROPRTATF. PROTErTTVF CLfWI'ITHO AND RESPIRATOR Stockton , California, <br /> J 16 GENERATOR'S CERTIFICATION I hereby declare that the contents of the consignment aro fully and accurately described above by proper shipping name and are classrfred <br /> Q packed marked and labeled and are in all respects In proper condition for transport by highway according to applicable federal state and inlerrsatwnal laws <br /> U <br /> If I am o large quantity generator I cerhfy that l have a program in plata to reduce the vchrme and toxrcdy of was»generated to the degree I haw determined to be <br /> economically practicable and that I have selected the practicable method of treatment storage or disposal currently available to me which mrremws the present and f ftm <br /> tlueot to human health and the environment OR d I am a small quantity generador I!sore madero good b <br /> fadh effort to mrrume my waste generaNbn and select tat <br /> he b <br /> r waste management metino�that is available to me and that M can afford t , s <br /> Q Primed/Typed Name ,SnFnataro + Madh pay Yew <br /> u Aik�rTTIE AT.I.EN t414(' I7CNAT.D 3 4 5 9 3 <br /> Z T 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> N Pr tV*9"mI4 T R T C: , Signature_[ ( � r lel�'' U 4Yew) <br /> w � <br /> o IS Transporter 2 Acknowledgement of ROCOV.of Materwls <br /> W t Printed/Typed Name i Signature i MorrM pay Yew <br /> Q l I <br /> N19 Discrepancy Indication Space <br /> Q F <br /> U A <br /> Z C " l <br /> 1 2D NdlOwner or gMator Cerhficahon of recinpf of haxordous motanols covered by this manifest except as noted in Item 19 I i <br /> I Mon* Yeas' <br /> T Praded/Typed Name <br /> I I I $sgtwlrrroY <br /> Y <br /> DO NOT WRITE BELOW THIS LINE <br /> I <br /> DTSC S022A If12/911 I III r I I f h I I Ili i t I`r I I f l I I <br /> EPA 870G--22'11 I' I I Yellows GENERATOR RETAM <br />