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Stole of Ca i(omb-Emirawsered Protection Agency <br /> Form Approved OMS No.2050-0099(Expire 9-1694 `i.f See Instructions OD back of y.rgo 6. Department of Tonic Substances Coin el <br /> Please print or type. Form designed for nese on alife(12pi cFt y,wwrler. - Sorrameres,California <br /> -J' Generator's US EPA ID No. Manifest Documee No. 2. Page I Information in re <br /> the shaded aas <br /> UNIFORM HAZARDOUS <br /> is not required by Federal law. <br /> WASTE MANIFESTfC 1A 1115 17 12 181(; In Ig h In 161T <br /> 3. Getbralor s None and Mailing Address <br /> NATIONAL GUARD OMS -124 <br /> 3010 S. AIRPORT WAY STOCKTON CA 95206 <br /> m4. Generator's Phone h ) 232-4415 <br /> els 3. Transporter 1 Company Name _ _ 6. US EPA ID Number <br /> ^P rAVIRJN!4E11TAL RECOVERY SERV. iA q 91 al 31 5 '11 Gi 5 <br /> 7. TraaporNr 2 Company Name 8. US EPA ID Number <br /> a <br /> V <br /> 9. Dedprebd Facility Name and Sib Address 10. US EPA ID Humber <br /> M U.S. ECOLOGY <br /> N <br /> H1JY 95, 10 MILES SOUTH I.� '11 Tj 31 1 <br /> V 12. Comoiners 13. Total Ie. U:sil <br /> Ln Z 11. IIS DOT Dacriptbn(htduding Proper Shipping None,Hazard Class,and ID Number) No. T Quantity Wt/Vol <br /> 0 2 a. <br /> c%j 3 WASTE CUNTAIIINATED DEBRIS ra <br /> O E i4 NON RCRA HAZARDOUS WASTE SOLID S 0 P <br /> w N Is. <br /> 4 E <br /> N R <br /> eeay <br /> e W T c <br /> O <br /> R <br /> W <br /> Z d. <br /> W <br /> U <br /> W <br /> N <br /> Z <br /> O <br /> a <br /> N <br /> W <br /> C <br /> Q <br /> Z I& Special HodEng hnlrucliarts sad ArfAam <br /> tlod h lo,noft <br /> USE PROPER SAFETY EQUIPMENT BILL TO: ENVIRONMENTAL RECOVERY SERVICES <br /> W EMERGENCY CONTACT - CHEATREC 1-300-424-9300 EMERGENCY UUUIDE # 31 <br /> x <br /> h- <br /> 16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of the consignment an fully and accurately described above by proper shipping name and arc classified, <br /> packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international laws. <br /> U <br /> If I am a large quantity generator, I certify that 1 have a program in place to reduce the volume and tonicity of waste generated to the degree I have determined to be <br /> 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 /> Ngreat to human health and the environment; OR, g 1 am a II quantity generator, I have made a good faits effort to minimize my waste generation and select the best <br /> .a*mmusipureart method Bat is available to rom and that I c6n offard. <br /> Printed/Typed Name Signally- Month Day Year <br /> V T 17. Tran r 1 Ackno mast of Roc ' of Mabriab <br /> A <br /> P /Ty d Name <br /> .// S:q ro Month /Y'ear <br /> W s C <br /> e <br /> o . Tram enter 2 Ackno e:rar:l of Receipt of MOMia6 <br /> LLE Printed/Id Name BipaNn ,-_MogtL_ Day Year <br /> rW 19. Discrepancy Indication Space <br /> Q F <br /> Z C JAN 2 5 1995 <br /> 20. Facility Ovmer or Oparator Certification of receipt of hazardous materials covered b this manifest except co rated in Hem 19. <br /> Y Printed/Typed Home signature PERMIT/SERICES Day Y. <br /> DO NOT WRITE BELOW THIS LINE. <br /> Blab: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DTSC 8022A (7/92) To: P.O. saw 400, SocrameMo, CA 95812-040D <br /> EPA 87g 22 <br />