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02/22/02 FRT. 11:22 FAX1949 450 1177 B E.S. I. IgjUO3 <br /> rt,P,orau vma Ivo,cuou-VUJy(txpires 9-3' - See Instructions on t of <br /> Pleasr.print or type, form designed for use cIA eli ul;RI Typewriter. page b. Deparlment of Toxic Substances< <br /> • I Ganeralors US EPA O No~ Saaramanlo,California <br /> UNIFORM HAZARD61LIS Manifest Document I 2. Pogo 1 Information In lite shaded prods <br /> WASTE MANIFEST �n,Ql � (� is rot required by federof low. <br /> j `1 S2 pr` _ <br /> 37Generafor's Nome and Malting ddress <br /> A. State Manifest Documrsnf Number <br /> ARC, <br /> 1Tf1]tIl11CtS Cay►�, <br /> P.O-Box 90877 9 9 101 D f t <br /> 8. Slate Genewnor's 10 <br /> A- Generator's Pfsone{ 310 1 `� �$ I US Angeles,CA 9()()06 <br /> o <br /> . A i6 <br /> TZ —�_LYIFL� LL°Lr ai 1 ISL__ <br /> rN <br /> S. Transporter 1 Company Name 6US EPNII ber ��� C. Slate Tronsporler's ID[Res ,f <br /> 00, <br /> 13eLsWril 1r'r1Vlrcirlrrle Services,Inc. D, Transporters Phone OD "' — L.L�I_J1 L 1 � _jasn.lola <br /> 7- Transporter 2 Company Nome 8. US EPA ID Number —-----------__ <br /> E. Sbfe Trwnsportars ID(Reno a .] <br /> •.. <br /> Asbury alviror)mantA Services F. Tran tar:Pham —.__"T' <br /> n —�����J O.L 8 2 7 7 0 3 <br /> Q 9. Desi I�jyaad Sf Address 10. US EPA 1D Number G. Stale Facllily s 10 <br /> z 12000.JNoTltyl�Al;ur�i,eda St"pt I <br /> Coxnllwtl,GA 5r0222 �GlAT 1010 1 1 3 3 5 2 H. Facility's am Q)537-7100 <br /> u <br /> 3)6 11. US DOT Description(inchxklag P, per Shipping None,Hazard Class,and 10 N,,m6er112. Containers 13. Total I/, Unit - <br /> Z 0.—' 00 Air� No. Tye (]"artily Wt/Vol I. Waste Number 1, <br /> _FE 3 TIN1203 P.Cr.TI siala134 <br /> �r G Mat RerWated as itRcRA EL%te) - Cr E— — <br /> b <br /> OD .�._--- — ---- State <br /> A - _—._.._.— _—...._. _ I ' EPA/Other -. <br /> Th: <br /> Go 0 <br /> RLis <br /> EPA/Olken <br /> z <br /> Slpfe ' <br /> W _ <br /> U <br /> LU EPA/Cllher' <br /> 1: Additional Doscilptipnt for Mnigrw(s Lisloi� — <br /> K. i"N"fiog Cgiles(or Wade,listed Above -- <br /> O 1 ft)�c51 o rtll:ATxJ2YlC8111 GB CTC R-WONSE(3T:l11)X 7 128 <br /> V) lilhe7+U12NpiiiCtrtiansfatezKietrtisnAfiaidtdasafJm►try,19f�6 G� <br /> a` HSC Citation.25170.r3 <br /> 15. ectal Handling lions an0 Adm ditia1—,aLI�ormallon � "-- <br /> ast�lixle gnr� 'ekf?rWear uAr'ist0 PDtecti m c:1 AArig. ARCO 4932 B.F..SI# 2'7069 <br /> Z (949)'153••5826(24 hoi rE mefgerlcy'Fhm*) 16 Futst Herding Way <br /> Uj (949)450-1010 Won-Ph 7Bwnto Sprrl) <br /> Stodd=4CA <br /> t- __ <br /> Q16, GENERATOR'5 CERTIFICATION: I hereby declare that the consents of this consign neat ale fully and accurately described above by proper shlp�Ing name olid are classified,packed, <br /> U marked,and labeled,and aro in oN respects in proper condition for transport by highw/y according to opplkable international and nations govommenf regulations. <br /> CL If I am a large quanliy generator;I certify that I have a program in place to reduce Ile volume and toxicity of waste generated to the degree I have determined to be Sconomitaliy <br /> a proeficoVia and that I=selected the prociicable method of treatment,storage,or disposal currently available to me which minimizes thepPreseni and future threat Io humor health <br /> and the environment;OR,if 1 am b small quantity generator,I have made a goT,d faith effort to r intmire my wash generation and select the best waste management method that is <br /> available to me and that I can afford. <br /> y- Pn' T�,,iu�Nc�rl>•�r�AF57:ns f?IJt 0i�.�11��a � Signalun� n rly Year <br /> 0 1 17. Trani rler 1 Achnowladgoment F eceiPs of Mderials <br /> LZ I <br /> W A Print Ty d ogle Signator !�!C <br /> Ute$. k \ ���� 1 II I Year <br /> P <br /> _ �� _— _ <br /> IL 0 18. Trans rMr 2 Acknowled ail of i t o!Materials <br /> d T Prints yped Na o Signature — <br /> 4lJ E 8 Monnh-� Day,..... Year <br /> a <br /> R —__.___ SJ_,L I� Ld 6 <br /> U P 19. Dlscrepanry fndicolion Space <br /> z A <br /> C <br /> I <br /> 1 2.0. Facility Owner or�eralor Cort4 IcalIon rf 'pt of hazardous materials covered aniFeSf o as noted In Item 19. <br /> Y Printed/ ` -Nam �Ty Signature ��ti —"—� v Q I <br /> 1Jonlh D Year <br /> -- - T r u.�- <br /> DO NOT WRI r:L W THIS UNE. <br /> D75C 8022A 11/991 Whiio: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS, <br /> EPA 8700-22 To. P.O. Box 3000, Sacramento, CA 95812 <br />