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Ii 't"�.-r•s.a ..�• h DeartmentattoxicOuoSranw,..., T <br /> See Instructions on bac o. 8e Department <br /> State of California—Environmental Protection Agency � � _ , ,. � Sacramenha,California <br /> Form Approved OMS No.7050-0039[Expires 9-30 11 fer .. <br /> Please print or type. ' arrttdesigned for use an elite Flt pikl 2, pa e i Information in the'shaded areas <br /> 1, arator's'US EPA ID No. Manifest DocumenttNo� 9 is not required by federal law. <br /> UNIF04tM HAZARDOUS::.'.;. <br /> WASTE MANIFEST <br /> A State-ManiWADo6m;o Number ods i - /�y��� ¢ ,u <br /> 3.''Generatar's Nartte and Moiling Address `Z'M {�u- <br /> t, <br /> ` �L $°S1ater*Gerator es ID rb <br /> Pue7 r �77 <br /> 4 GeneFdtar s'Phone[ I C State 7ransporlers Id llteserved j r .. f s <br /> tV " t�1 CIFTi 6 U5 EPA ID-Number .tx'"aF zp. <br /> kl <br /> lin <br /> :co co (559}4 8-0240', �i,s t, - <br /> 8. US EPA ID Number E State tronsport1i?i iD f Reserved) �z <br /> 7-L.Transpo'rfer 2'Cotnpany Nome. <br /> Q.:J - - - '_,y-� +4a.r. v;�' S _wS.e „3 f�ati S•�€ L..: -,"3�'�iC <br /> a-r �• u,��",`t- 5- <br /> ID rH. A <br /> "state Fa ry c 1:,;� .�^=, �,F "u�` �� .i; �• <br /> Q . ._ - '10:`US EPA lD Number ��''�:,��g f #i' :,'r�-`,' <br /> Site <br /> Address <br /> MgtV -'Desi Hated Focili Nameand _ <br /> �i 9• g h r a i1 P r3 <br /> �'a Partici'Facility-_ l4?87 E. Ivlairiit>g r1xrt <br /> : <br />