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01/26/2010 12:43 FAX /2008/018 <br />Stow of Callfarnio—Enn'raemenldl Pra.el rut rrg.nry -79-7S,;I% <br />Form Appn•P,d OMB No. 2050-0039(E.pires 9-30-991 See Ins}r Ip its an bock of toga 6. ` pnc,lmenl of Took Suhe}ancm Cannot <br />Plmse oder ar nae Farm dnlaned kr us. m.lir. NY-airchl Npevrihr. r, AO w— /IM OV G Sacramento. California <br />DO NOT WRITE BELOW t AS LINE. <br />While: TSDP SENDS THIS COPY TO DT6C WRNIN 30 DAYS. <br />DISC 90224 IIYW) To: P.O. So. 3000, Sacroreenlro, CA 95912 <br />EPA 11700-22 06_-08_06A08!26, RCVD <br />1. Gmeumr'r U D ID No. Manif.d Oe..m.N Na. <br />2. Pap. I Informallan i^ the shad.d or... <br />UNIFORM HAZARDOUS <br />irnet reuindb,Federal I.,.. <br />WASTE MANIFEST <br />Z <br />or 1 <br />3. Genermoh Name and i0a:ling Address 7— <br />A, $11, rwnl60 Daeumsnl Nvreber <br />25049762 <br />SlclaGanaroto,'FID <br />A. Ge..not •Phone S <br />S.TwpnfppeA�vpl Oma d. U AIDNum6a <br />C. Stow Tronepaitors lD Rasaned.j <br />pC�olnpeny <br />RO�s ALZ <br />C. Tromps 1" thane 510 <br />P. Twarle�lanY Nam pTI� B. US EPA ID Number <br />E. Stole Tmnspomi s ID IResencd.j - <br />LL221111 DIAT.1NI90�ile I ._ <br />.. Tmvpariere OR.. 4019 7 <br />9. Dmignated Facility Name and $14 Add.... 10. US EPA ID Num6.r <br />G. I Faci iq+s 10q� <br />21ST (IMMUR4, EMI <br />W. feeihy'. free,vmwnY, <br />2095 NEWL6ANDIS ERM RAST <br />Nv 89408 <br />775-5'75-2780 <br />11. US D.rcription (including Proper Ski ping Name, Horord Our, nd ID Num6m) <br />12. Canlaimn <br />13. Teml <br />Oaanh'ry <br />16, Unit <br />Wi/vel <br />I. Welty Numbee <br />Na. <br />i <br />N�,,d�r <br />993; <br />EPA Ot/heir <br />G <br />u¢Jfev <br />E <br />N <br />b, <br />sure <br />RFPA/dh.r <br />A <br />T <br />Seale <br />O <br />R <br />EPA/Other, <br />d. <br />5tcts <br />EPA/Other <br />J. Addiii... I Dntqm.ipplivn. F/«04a4riale Us6yd Ab., - <br />K. Handling Cada for Waswr <br />Orl.d Abm. <br />d. <br />lie <br />11d <br />15. Special Nandllog lnmwtlam and Additional nforma* <br />S_R_G_ 4F <br />M_r y� <br />5-7455 <br />24 OM I CY CONTArr_800-87 <br />Ii <br />16. GENERATOR'S CIRYINCATIOW dexrl6.da6we6yprop.,,ki ping nano an darezlmdhed,pack.d, <br />merle, and lo6eled, and are in oil respells in proper condition For transport by Fighvry aaordiig to appliwbb im.molienal and noriond go mmn�nt r.gulaliorw. <br />II I am a large quonliry generator, I mxihj tha I Fine o pr ram in place u ndvu the whine wd roziciy of we4 penera4d to the d.pne haw determined u be economicollr <br />me ..hick mim n... the pnwnl and fvlau Ihrear a hums^ hcallh <br />proctico6le and thor I h a .l'o'll the pnactim6l. mdhod d Inelmml, xenp., or d4p.ra1 cvrmNy awilobls on, <br />faiththe bag method that ii <br />and the . . r OR, ff I am o smoll c liry geoaobr, I hose made o good 'Non he minimae my wase generation and felon .mete management <br />woiia66 to on. and that I can aFrard. <br />Prlered/Typed Name <br />Signolvn <br />I Nmndt DoT Year <br />Q <br />7 <br />17. Tre of arler I Ao Ib eme of Repel 1 al abrlelD <br />APrinl.dRytad <br />Na <br />Stan lure <br />rh Day Year <br />R <br />s <br />e <br />I9, iron eA 2 e,le w al Gni r of Maedah <br />t T <br />Primiciontdtal Nome <br />i9n.N <br />nlomk Day Year <br />I <br />9, DhvoPaney lndicad.n Pac. <br />IF <br />A <br />C <br />I <br />L <br />I <br />30. Pea11i O,.mar a.O cuter C.xiheation of nut roF hazo,dous mmrlols <br />mend 6 this manihrt ezc. t m Henri in k. 19. <br />T <br />Prioled/TrPed Nome <br />Sigmfure <br />D.rrm Do, Y.or <br />DO NOT WRITE BELOW t AS LINE. <br />While: TSDP SENDS THIS COPY TO DT6C WRNIN 30 DAYS. <br />DISC 90224 IIYW) To: P.O. So. 3000, Sacroreenlro, CA 95912 <br />EPA 11700-22 06_-08_06A08!26, RCVD <br />