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Stale of California—Environmental Pmtecnon Agency <br /> Form Appromd OMB No.2050-0039(Expires 9-3094) See Instructions on back of Nage 6. Departraem of Toxic Subd«scm Camral <br /> Please print or type. Form desg l fogcse on elite(12poldt)yptwion. LL Soaareenp,California <br /> UNIFORM HAZARDOUS 1. Gwraler's LIS EPA ID No. Manifest Daament No. 2, Page 1 hvicte ation n the shaded areas <br /> is <br /> WASTE MANIFEST ^-� ret required by Federal law. <br /> I id - 7 n n r1 <br /> p 3. Generators Name and M fling Address ; <br /> s✓.,; <br /> J I is L.1.TC11 CA 15205 � QtaP°B41D' .. <br /> A. Generator's Phone <br /> m <br /> h S. Transporter 1 Company Name b. US EPA 10 Number Ttaraporfei s ID <br /> EiJVLi ;2L U4E;tY S"t'k'. 6Flo tTp'7 <br /> Q7. Transporter 2 Company Name 8. US EPA ID Nsmnber Trmsp msr's ID " <br /> U s P1wro <br /> Q + <br /> q. Designated Facility Noma and Sib Address10. US EPA ID NumberFatdalq's <br /> 3 .;KK <br /> N "� J. ,i 1Si1 l` i e ieys Phone <br /> 1 <br /> CD Q i 7n, 1 71 <br /> U s - <br /> Z 11. US DOT Description(ilung Pr Shipping No ,Had Class,a ID Numb ) 12. Containers . 14. Unit <br /> No <br /> Tnpa vn/Vol Number <br /> NJA <br /> G n:OJi .<L'n iL4J 'uS trlbTE -'ULIC 01 :, r p � HEry E <br /> a�g N b. <br /> E <br /> R :,EPA/qb®r <br /> x AT a• <br /> R oher <br /> W <br /> Z d. <br /> W <br /> U EPA/Other <br /> N <br /> Z J. Additional Descriptions for Materials Listed Abom illhg Codes f«V✓ossas tined Above <br /> N `b. i <br /> W Ila WASTE BRAKE SKO .. w <br /> o: <br /> a <br /> 0 15. Special theadling InshsMions and AddBional Information <br /> a USE PRGPL;tT}' z JIPIIEGT ILL TO. ciiVIRGYME11THL RECOVERY SERVICES <br /> Z sJ'IERGL;ILY E:.-1'ILT - LI12:!T'',ELL .-" JO- If2?- 330 ZHERGEtICY GUIDE 1 31 <br /> W <br /> r 16. GENERATOR'S CERTIFICATION: I hereby declare that the conteas of the consignment ore lolly and accurately described abase by proper shipping name and are classified, <br /> packed,marked,and labeled,and aro in all respects in proper condition for transport by highway according to applicable federal,state and international laws. <br /> U <br /> If I am o large quantity generator, I certify that I ham a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and Ma I ham selected the procticable method of treatment,storage,or disposal currently awilable to me which minimizes the present and future <br /> yaj threat to human health and the envirorsrenl;OR, 'd 1 am a small quantity generator, I ham made a good faith effort to minimize my waste generation and select the best <br /> 6, waste management method that is awilable to me and that I can afford. - <br /> 0 Prinbd/Typed Name Signature Momh Day Year <br /> ZT 17. Transporter I Ackrowled mea of Recei t of Mabriols r <br /> Pr#*d/Typed Name Signcrlum Month Day Year <br /> W Is /_ /" <br /> 0 1 T.Lr 2 Adaowleclenrorh of Receipt of Materials <br /> W j Priasd/Typed Name Signature Marsh Day Year <br /> 0 e <br /> Q <br /> W 19. Discrepancy Indication Space <br /> N <br /> F <br /> U A <br /> Z ` JAN 2 5 1995 <br /> _ E <br /> 1 Z0. Facil' Owrmr or rotor Certification of mcei of hamrdous materials cawmd b this manifest exceptas noted in hem 19. <br /> P nted/Typed Name Signature <br /> ENVIRONMENTAL E D°y Yea, <br /> PERMITISERVI ES <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (7/92) <br /> EPA 8700-22 <br />