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P;1ar 05 08 01:14p p.3 <br /> StaredYColiforzlc-EnvironmentalProrectionAgenc a 5rr ]"Sil�ilt iva S 0� �{k[1( „ r.ecartmonTo:T—ickbs:cncesControl, <br /> Form Approved OMB Nc.2050-M9(Exalres 93{3.9, <br /> Please oriw cr ryas. Form designed fo_use on elite r12-pitch)typawrirer. Sacra:^sato,Ca Ifan,.c <br /> Generator's US EPA IC No. Va;iles �ecumanl t lo. c. ?ayo nF :,titan r the shcded:rets <br /> UNIFORM HAZARDOUS s ncl a mored:-y Federcl is <br /> 'IN.45TE MANIFESToI V' Ir -3I I <br /> 3. Generator's Neme and Meiling Ades <br /> drs A- Steve rJanifest DaCwment i*grmgsr � Y <br /> SIII Z] I .^ .r F'lr�2c; ✓ � <br /> E. scala Genarolor's 10 <br /> V)+ A. Generator's Phcne ( 0-,?Lt <br /> h <br /> Lti - -rcnspercer 1 Company Nome 6. U5 EPA ID Numaer C_ Stale 7nnspute is Ip[P,eserve <br /> 5 d.] <br /> �? <br /> D <br /> ' ' s tter's Phcne <br /> O -7 <br /> f <br /> ea . <br /> 7L15j EPA ID Number E. Slcle Transportar's I Reserved.1 <br /> - rte ColzPanY f+ (�^ <br /> .rte •- cl } F. Trcr=orier's Phone <br /> a (a CA <br /> �u 9, DDes;crrcled F ciky Name and Size Address 4D. US EPA ID"lumber G. More Facii'.i9y's ID <br /> �Q 6.AT C-1h ]'l sem <br /> ✓— F <br /> � <br /> � ] H Fac 1'}'s Phone <br /> ne r.1 <br /> 12. Carlainers 13. Taro' I Unir <br /> I I US D'CtT Description Uncloc ng Prower Shipp;.q ylcmo,1-icza-c Class,and ID NumLer) No. Type Ouantily WtfVal 1. Waste Number <br /> a. State <br /> 1:,y l.r'4�.i,� :5e`- I G /\ <br /> i, n ,.y EPAfdlher <br /> ;�� ri1.4T !r V <br /> E Slate <br /> aco <br /> N <br /> co <br /> CPAlQlher <br /> � R � <br /> State <br /> c3 EFAlOther <br /> R ' <br /> p[ State <br /> w d. - <br /> r <br /> Lu <br /> EPAfr..vt'her <br /> V <br /> Lu K- Hardiing Codesfor Wostcs IUz'ec Abase <br /> ry J. Addirionoi Descriptions for Motericls Listed Above <br /> CL <br /> Lu <br /> c& c' ' <br /> z16. Specials iia11n-'dkgjl_nsirw5ftions anjd Additional Irfarmahf n <br /> Q tJ]t� .J TWtit3�i^'�'` Su,#-�� �4ji G�V]CK.�� [y�rl.G'l J, -►/' �l i <br /> Z <br /> Lu <br /> I6 GENERATOR'S CER ICATVO : I hereby declare ibat the contents of tnis consignment are fwlfy end accurateIy dnacribed above by preoer Chipping name and are;lassified.pec ed, <br /> Q marked,and labeled,and ere in ell respects in proffer condition for transport by hig.nv ay accarding le oppkiimbie invernarinnol and rat oral governmrnr-gr.lnFC-. <br /> If I or,a large gnantity generator. I certihr that I have a pro ram in slate is reduce the✓olurne and to>iclty of waste generated to Ih:�degree I home determined to be economically <br /> practicable and Shat I havn solocted the prov,cable metf of Ireatnsent.storage,or disposal currently available to me watch minim_ee IFe prasent and Iwtere fhreo9 a h man health <br /> and the environment;Ok if I am a small quantity generator,1.have rands a Good Foiri,effort to minimize ny waste generation and selee the best wood manacemeit rxethod Thal is <br /> available to me and fhcr V can afford. 11 _ <br /> © rn <br /> fated/d ped Mae Si at're�t on+ Dam Ye,ay.. <br /> I <br /> v �rte Lll' <br /> Z <br /> LLA - T 17. Trans otter 1 AcEnowled emenl of P,ereipl of Materials - <br /> ujt fere Signature �'v^anrh+ De vj Year <br /> Ltd i � i <br /> w P — <br /> w- R 18. Trans atter 2 Ackna,,viedaemoM of P.ecwl of 1J,nterials - �Wlansh paY Year <br /> Q T Fri d/7 ped C3a �.` 5igra rs q G J <br /> �; A (�CnL' I c <br /> U19. Discrepancy Irdication Space <br /> Z F <br /> A <br /> C <br /> I ' <br /> L <br /> s 20, Fa-;1iW Cwner or G stator Csri&cation cf recewt of hozordvua materlals covered 2X.'6"h aast'desl uncevt as noted in Item 19 <br /> T Fri }Typed NamQ i Sigrature ! <br /> /9 1 + �J 6 r <br /> [DC7 NOT W17-f L"NE, <br /> D75C 8C 27A it l 9i <br /> EPA 67CO-22 <br />