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State of California—Environmental Protection Agency - <br /> Form Approved OMB No.2050-0039(Expires 9-30.99) See Instructions On back Of page 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite 112-pitch vriter. -' Sacramento,California <br /> I generator's US EPA ID No _ Manifest Document 2. Pae 1 Information in the shaded areas <br /> [JI1gIFbRM HAZARDOUS ` + g is not required by Federal law. <br /> •- `WASTE MANIFEST of <br /> Y - <br /> 3. Generator's Name and Mailing Address ,' t A. State Manifest Document Number <br /> i , S H A R.L1-'11N f 2--'2 5240 4" 5 <br /> O F �, _., _C` - B. State Generator's ID <br /> 4. Generator's Phone (20P) 98'.3-6 5'70 <br /> CV y 5. Trans;�rt*►r 7 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> 6 f{ I \ <br /> rr E� XFE-TV—19.1,Er-N E'.MS: <br />