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Se"of Caldorn o--En.:ronmental Protection Agenq back'--red OMB No 2050-0039(Exp res 9-30-94) Sm Inslru�pact( 9e 6, Department of Toxic Submences Control <br /> Plcose prim or type. form desig o i for Use on elite(12-pid 46writer. <br /> Sacramento,California <br /> UNIFORM HAZARDOUS1' Gesnaelos s US EPA ID-.N6. ';; Manifest Document No. 2. Page I Information in the shaded areas <br /> WASTE MANIFEST <br /> is not required by Federal low. <br /> Z � of T <br /> 3. Generator's Name and Mailing Address <br /> in LIBBY=OWENS-FORD CO. <br /> 500 R. LO(U�,fI�SE AVE. <br /> Tp <br /> 5. Transporter 1 Company Name y` `v� 6. US EPA ID Number <br /> oD <br /> STAMOOAUXASTE CAD063547996 <br /> J 7. Transporter 2 Company Name 8. US EPA ID Number <br /> U <br /> U 6 <br /> Z9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> N o U.S_ ECOLOGY <br /> M" HWY 95, 12 MILES S_ OF BRATTY <br /> N BEA NMDA 89003 IN IVIT131310 loll lololola <br /> 11. US DOT Description(including Pmper Shipping Name,Hazard Class,and ID Number) 12. Cant°ine s 13. Total 14. Unit <br /> M Z No. T Qua Wt/vol <br /> M� a. <br /> �3 c HAZARDOUS WASTE, SOLID, N.O.S. (D007),9, 8 sty <br /> w E <br /> m <br /> N b. <br /> E <br /> R <br /> $ A <br /> T a. <br /> R <br /> Z d. <br /> � u <br /> Z <br /> 0 <br /> N 1 <br /> K I <br /> J <br /> Z <br /> I <br /> O 15. Special Halling Instructions and Additional Information i <br /> Z RMER GRNCY RESPOSNE GUIDE NO. 31 <br /> = 24 HOUR GRNRRATOR PHONE #(209)858-5151 <br /> WEAR GLOVES RYE FACE PROTECTION AND PROTECTIVE CLOTHING AS NECESSARY. <br /> J 16. GENERATOR'S CERTIFICATION: I hereby decksm that the mntenh of the consignment are fully and accurately described above by proper shipping"me and aro classified, <br /> J ed,marked,and labeled,and are in all m r condition for transport b highway according to applicable federal,state and international laws. I <br /> Q 0-°s* respects proper spa Y 9 Y n9 Pp' <br /> U <br /> If 1 am a large quantity generator, I certify that I haw a program in place to reduce the wlume and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and that I haw selected the practicable method of freatnem,storage,or disposal currently available to me which minimizes the present and future j <br /> Nthreat to human health and the envircrmenl;OR,H I am a small quantity generator, I haw made a good faith effort to minimize my waste generation and select the best <br /> waste morusgemorrt method that is awil.ble to me and that I can afford. <br /> O Printsmi/TypeakiT wElss Sig Month Day Year <br /> / z <br /> ZT 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> e <br /> W Primed/ Nome ' Signature Month aor <br /> W NS �, �� a <br /> 0 18. Transporter 2 Acknowted emem of Receipt of Materials <br /> W i <br /> Printed/Typed Name SignaMonth Doy Year <br /> LL <br /> O ■ <br /> W 19. Discrepancy Indication Spon <br /> art <br /> Q F <br /> V A <br /> Z C <br /> 1 <br /> L <br /> l 20. Facility Owner or Operator Cera ifical on of recti t of hazardous materials covered by this manifest except as noted in Item 19. <br /> TPri d/Typed , Sig Month Month Day Year <br /> (H1�(1` �1 \ 2 2 `6 `1 <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> i DT5C 8022A (7/92) (Generators who submit hazardous waste for transport outof-state, <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />