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Si of Colifornia—EntiranmenrBl Prowcdact Agency <br /> Form Apprevd OMRNe.20SIM' 1Rwhw x•70.9% Sums Instructions an back of pago 6. Depara,,.,d.6 Toxa srbaanar conrral <br /> %eau print or Npe. F..desipi For a a an elita(12-pili tyswriNr. S.cmmenta,C.Ilfrnla <br /> UNIFORM HAZARDOUS 1' Genammfs US IM ID No. MandeN Dacmuwal Ne. 2. Pnga 1 Infmimi In rhe rhaded erooe <br /> WASTE MANIFEST n + t �,, t cP a net reauirod by Federal law. <br /> C Y i. iJ 6) <) } <br /> 3. rDuritim 'e Nene and Mailing Addaat I A 51410 MoniPert Oaeweed Alum rteA^^nn 6 1 <br /> L�5 8 T. ";SI ApfF P EY I, Stan 9enRatee.IO <br /> ya. Omteat./e Phone(20 911 :.SECrZtlp> 55333 <br /> h 5. Tramparter 1 Company N.. 6. US EPA ID Nembor C. State Ttanporrar's ID Mi agaw <br /> ♦ y D. TransParteh.pkam• <br /> '"�4&+ <br /> y. TmaiptwNr 2 Company N.no 9US EPA IO Number S. $tele Tnao.pei10.R•wd.l <br /> F. TroneRarw'i phone <br /> �V <br /> 9, Omi natd Facilly Namaa flN Address 10. US I94 ID Numhr G. SIoN rudilityslD , <br /> �d QX�So;agvlraaaeluxt <br /> t?'J4 :KS Fir.6°Saiat N. facility's Phone,, P . <br /> fAmr2m,CA, 91.102t)03 C ,0.D 0 5 3 0 2 D G 3 1s) <br /> 11. US DOT Dacri INn ludo Pe Shipping Namo,NPeard Clare,and 10 Nomborl 1 • Canminers 19. Tdal 14. Un <br /> V P li"c B ^M' PP B Na. T e Ouanrlry WI/Y.11 I. Wab Number. <br /> gw E b. Sma .. <br /> a3 N <br /> E SPA/OdiFr <br /> v R <br /> g <br /> T SroN <br /> T <br /> O <br /> &A/Ophw <br /> r R <br /> 'BAy01hw <br /> 'AddWon.iNvalpflimlifol Mo:xlols Usled Alow. K. NondlYq Godes fen Wastes lidd AEaa . <br /> 1 ,?�(1D7Ccf1+,AuuEri� C4EDICY x7.RSPC)1rTS3v171P.T.'IN Y+3C�. :33 a., h. . ', <br /> Ja. r .. <br /> QISi 4 F �( "lf il�Au i�'9iS:4° r ml'- `tres'saall'l`.WW.am"fi_ii:':i+ lr'<.t3LS FFtL1AS�k �G1, lYr'':� <br /> Z �1TpDe1Q!o;d ylp[�111�,I716p) auAFi-3"•fQfi (,'J3'1L2Y�'1CIt$oMt}+FFAil7lii / Es «.�i i >`I;i L. <br /> ou (S4a)4d4.5=r -Fn 7dm to Spm') ; <br /> d 16 GINISMYOR9 CIRTIFICAMON; Iherp <br /> 06 chmiaro A.Pthecanivi this full one acau d d0eari6nd above h)pray dtprng name and am elesslhad,packad, <br /> V marked,atd Ia6Jd,and aro in all nseeh in proper condiaen Nr Yaapan by hlghwoy occo4ing to applimbia haunctlanal prepay <br /> gawrnmant...ulafiem. <br /> aII I am a forge quanFlq gararatap I"Oily man]have a program in plan le rrduoo the ualums and toxicity of worm gunufald N tha degas I no" latormined w be eeanomica <br /> a pradkail.and that I bane mi 16.practicable wafted at IngOMm,;.raga,or dlpowlaur,.dy..11.610 m me whish mi.Imixw Iho paval and{uNra Au.,n human 6,04 <br /> m and the envisanai OR,If I em a snpll quantity ganembr,I have mads.good faith.Red le ndnimiw my wash ipaveall.n and Nled the br01 waaa manogomant method that It <br /> Oari le me and iI opo.9ard. <br /> printedyTypd blame Signe i Moat6 Day Y., <br /> �. <br /> i 17. Tone onar 1 Adnawld em nr I Reoel r of Moierio.. <br /> w I nNd/Typd Na . Signa _ - - Mwdh 0^y' <br /> Year <br /> W 0 le. Tran rbr 2 M wl emeN 'I t Matruh y <br /> P Prinrad/Tlped Nene p Na Manlh Oay Yea <br /> N g <br /> I <br /> 'raj 19. Dlserp ';alien omy In Spuce <br /> Z P <br /> A <br /> C <br /> I <br /> F.dlim Own.arrat.[artifice' f rue t-I ar o matarieh coversS,this.ani I •noted 1rt ffimn 1 <br /> T Mnled/Typad Name Signature Memb Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DYSC 8022A(1/991 Yellow: GlNERATOR RETAINS <br /> CPA 67OD-22 <br />