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UNIFORM ,.r. - r u u�tton5 --- <br /> HAZARDOUS on back of _ <br /> 1. Gp- �tor's pane 6. <br /> WASTE MANIFEST us EPA I N°. De -r <br /> Monifest Document No. P ant of toxic CalifSubsnces <br /> 3• Generator' 7 Sacramento, Control <br /> Generator's Name and Mallin , 2. Po C-IiForifi° <br /> 9 Address �� \ ge I Inform-r n in theshaded areas <br /> is not re Ared by Federal law <br /> "'M' RICAN VAI L EFY °f <br /> 1�.0 BOX,34() A:STE(�II INC A. StoteMoniFesfDocumentNumber <br /> 4• Generator's Phonef�i7U �.�2_ <br /> rl6,4 y DFL.I-ij t ' <br /> 5. transporter 1 Com C'p` ' 539.5 <br /> Pony Name 8. State Generator's ID s <br /> it. 6. US PA ID Number <br /> nLLErV WASTE COIL <br /> 7. Trans C. State Porter,ID <br /> porter 2 Company Name (� !'; jj <br /> [ eserved. <br /> 8. US E A ID Number 18 <br /> 7 D. Transporter's PhDn <br /> 9. Desiynoh�d F E. Slatrons <br /> i t�.�L'I i r73/r{r,)h�I f L n�ee i�and Site Addre�s Porter's ID(Reserved) <br /> S Jr;hID. USE F. Transporter's Phone <br /> CLAUS 14OAL� ID Nvmber <br /> f 1VEf2(3ANJ5, G. <br /> C Stale Facility's ID <br /> 1 US DOT Description(includingH. Facili <br /> Proper Shi t ty's Phone <br /> a. pmq Nome,Hazard Class,and ID 7�d1 G� <br /> umber) 12 Gy' V[. j.. �?., <br /> !,A HA Air' WASTE f c-nfain�Pa <br /> No. T 13. total 14. Unit <br /> f I„1+;EI-j oil. .t TE Lla ul Ouontify Wt/Vol 1. este Number <br /> b. C <br /> 5Ic e <br /> t t T 1 �� •� c��'j <br /> VV h <br /> FP Other <br /> c <br /> Stat <br /> EPA Other <br /> d. <br /> State <br /> EPA/ ther <br /> Additional Descriptions for Materials Listed Stale <br /> USEC� EFi aVe <br /> EPI her <br /> f . Handling Codes for Wastes Listed Above <br /> 5or S-6 �� a b. <br /> "I <br /> Special 1111:11 Instructions and Additional Information C, <br /> d. <br /> GLCSVES <br /> EMERGENCY PHONE 209-h67-•88.57 <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents Of constgnmenf re <br /> marked,and 1-baled,and are in all respects in proper condition for fr nspo is con b <br /> fully and accurately described above by proper snipping <br /> F 1 am a for Y high oy according to applicable international and national <br /> large qu°ntiy generator,I certify that I have a r name and are classified <br /> tactic-ble and that I have selected the� cked. <br /> nd the environment, P o ram in place to reduce t e volume and roxici government regulations <br /> OR,if I am°smollrachcable method oF treatmen <br /> voilable to me and that I quonfi storage,or di posal currently available to me which minimizes the present and ter threat to hu <br /> can afford. IY 9enerotor,1 have made° IY of waste generated to the degree I have determined to be ec nomicall <br /> ulu <br /> I/Ty ed Na good foil effort t inimize m w <br /> Y este generation and select the y <br /> / best waste m an health <br /> '1/ Signature Ono met ad that is <br /> sns otter 1 gcknowled ement of Recei f <br /> 'TYPMaterials / <br /> edrNome r .�. ��._ t/ nt♦ri" a <br /> y <br /> Signature <br /> �s o er 2 Acknowled email of ecei t of MafV ,T� <br /> TYPed <br /> Nomtrials N___._ / ant t yDa , ---_.year <br /> Signature tl <br /> raponcy Indication Space , <br /> Month Day Year <br /> Owner or O erator Certification of r <br /> Nome ecei t of hazardous mareri-Is covered <br /> Ped � <br /> 'f 1[sRs m nifesl exce 1 os noted in Ile 19. <br /> Month <br /> Day fYecr <br /> DO NOT WRITE BELO ' <br /> W THI,�' LINE. <br /> .._...... <br />