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A-14-2001 8:06AM FIR ###### 000 0000000 P. 1 <br /> Stora of Celifoenio--Enviroll mental Pratuctiois AqN iry <br /> Far,ri ApP'"d"ad OMB No.2050-0039(Expires 9130-99) See Instructions on beck "Oe b• Drpartmant of Toxic Sr+65tnnces Control <br /> Please print or lypq, Form dosignvd Far v on alit.f 12-pircftl typmv+'i19r. Suvwncrr to,California <br /> F e 1. Generntor',US EPA ID No.Y Mc haat Document No. 2. Page I Information in the shaded ardor 1 <br /> UNIFORM HAZARDOUS is not roquirad by Fedarol law. ! <br /> WASTE MANIFEST L ? M'' �� of <br /> 3. Gonomtor's Narto anti hhailing Addrosr„f. f' C �r3.�.f'� ;M p,a 11 fes` A SAoMQlf10f19t1,D0CVm�nf�lu6r �li1 JY�� 3. <br /> d TCaC �' -�:+<r�r,e 'i' •��:7rk.lY1 �W j 1�� , ,. > <br /> t fs etkrr'a ID <br /> R ja <br /> 4. C.onoroior'n Phony I.7• },.,, -. - ' <br /> 6. US EPA ID Number sR ' <br /> (y 5. 'I'ran5pori0r,1 Company Na me ° <br /> � d rwfvlpi�At�i• � ra:l;, <br /> W � 8. US EPA 115 Number 6 rroRtFldr�F.•►70 <br /> 7, Trpnsporler 2 Company Ni <br /> .res 9. Designated Forllity Name and Site Addre>s 10, U�EPA ID Number `*'�' �- r t�•'` <br /> ri <br /> "r`" 'i-T��^ L 1112. Contarnor_c 13. Total 14. Unit , <br /> 11, US DUI Uescriptioox(including Proper Shipping Name,NrrT.ard Class,and 1D•NumberJ No"'"'- -7�, a ""onfily -WI/Vol ,I. <br /> — Stau <br /> 14 <br /> ~ {f /V ! �h�r' <br /> EPA <br /> R t?tkeir ' ':S•. <br /> v w <br /> N Skate <br /> R <br /> Pis <br /> fpr Wgiiw%1t 4d Abm'&• <br /> } Additidiauf DMtcriptrmg5 feX'•1Msellpejph lura¢ "�� i J y, <br /> M]gnidt?ng CtifAe <br /> r <br /> % a <br /> LU • . �. d, .. <br /> d 15. Spacial Handling tnatructions ot on <br /> and Additiorioi inlorm <br /> Z <br /> LU <br /> l^'n e'" t„"t..rl.. lt--y qtr R`.f L <br /> 16 GEtJERATOR'S CERTiFICA110Nr I hrraby declare tkaP the enntcnts of this tonxiynman0 orn ful y and ue,curalaty dtrtfribad above by proper oh ppinq nomo and are cloxi:lied,pricked, <br /> < mprl ed,and Inbnlod,and are in ail rabp9r.ts in proper condition for fr(M port by highway oceording to applicable intaro+at onvl and national govOrnrnant repulallonx. <br /> rhe d rce I kava dbt0rmined to 6e economicoll <br /> if I pm d largo quanl�ly y9nnratar,1 certify 4hal I})aud n pr ran in Placa io reduce the volume and toxicity of wasto generated to eg y <br /> pract{e,r4>In nnd that 1 have'eleckd the practicable method of Ireco em,storage,or din -1 currer ly oval to-0 which min'imizox the pruaant and future Ihraot ti+human hnahkt <br /> and the rnvironrnoni;t7R,if 1 om a smell tluontity generator, I haWa made d 9 faith effort to rpin;iriv;my Waste generolion pnd solea the beat waxt0 mnnaIi-ent method ifroit is <br /> dvoilahlc-to mc ani Ilial I Con afford. <br /> 09 -` _ <br /> ig .� _ Mari <br /> Snrrlure <br /> �.. ¢rintod/Typed Name •,'� �^r'_ <br /> ua_t 1/ Trans' ricr 1 Acknci etnett of Ror_eipt of Mate6uli, -• "^ ' <br /> p Signature �r7 Month f?(ry Year <br /> I' <br /> w p Printed!lypad Nome <br /> p ra 64lOrtar 2 Acknawledflrnn4hi of Rene ipt of Materials ,,,...�-.� ManFh Dny Year <br /> YPrinMd Nmmil Signature J <br /> U. 8 <br /> 19. Diactdpancy Indication 5179- <br /> Z F <br /> ,A, <br /> C <br /> 2D Faeility Uwnar ai P179rator Csrfificafivn of rncaipr of haxgrdoux malQridIs covered b„v�thia n+anifext oxcopt as noted in hem 1 9. -^- w, - Month Day Year <br /> T Printad/Typed Nome Signature <br /> Y _ w <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A{A/97) Yrllnt•r 1;e1VGkAlf„}R 'AF <br /> FPA'97DD-22 <br />