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See Instructions':cfions an backc Cam,.,nIQ
<br /> Protection Agency , .: .j
<br /> 5nyironfnentcl 7-- areas
<br /> State of eal i(S)rnia— 9-30-99) —iter. Information In'the shaded a
<br /> form AppPoved OMB;1-4.�0500039(Expires ()2-pi h, 2, Page I required,
<br /> Form desigried for US or,orito Manifest Document No' is n by Federal low.
<br /> Please print or 3rator,,,US EPA ID No.
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<br /> A 7
<br /> UNIFORM 'HAZARD �iE4;st�b6c6nii�t5lSlum I.77'K'
<br /> �k State GI
<br /> MANIFEST 12 1'� 1 2, W
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<br /> WASTE MA . - . ,7r,-
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<br /> Generator's
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<br /> M. 9 G1,4 0 -B jst�aw.Gfr iih'er
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<br /> _tro t., CA
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<br /> 5200 _j1a
<br /> 3 2C34-5700
<br /> to Phone
<br /> ur A, Generator's6.
<br /> 5 EPA ID Number
<br /> Company Name
<br /> C14 5. Transporter t t
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<br /> 6 US EPA ID Numbor
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<br /> Facility me and Site 9, Designated
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<br /> -323, 25y'
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<br /> cc
<br /> 90( 13. Total
<br /> CA )23 Quanhly .Wt/vol 12: Containers ,; : u ..........
<br /> Class,and ID Nu-6er)
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<br /> 1 1."US DOT Description including Proper shipping Name,Hazard tote
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<br /> .22 15..Speual Hvndfing instructions and Additional information C lwL�. � �y�1. J`�
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<br /> GUY
<br /> LILI h, lame and are clo,ssiked,packed,
<br /> is con s� ot are fully and accurate( described above by proper shipping I regulations.
<br /> 8 1
<br /> I hereby declare t the contents of I i e
<br /> for transport 'app applicable international and riationa government rogu 0
<br /> GENERATOR'S.CERTIFICATION: r condition highway oc.cording t.a
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<br /> marked,and labeled,and are in all reSper 5 in pr to e economical(
<br /> to the degree-1 have determined I
<br /> educe the volume and toxicity of.-asto generotocl -an he"I
<br /> I certify that I have pro ram in p Iac&to r which minimizes the present and future ihr6oi to hu
<br /> Y available to me
<br /> If I am a large quant, generator, a treatment,storage,or dispc�sul current imize my waste generation and select the best waste management method that is
<br /> d that ILve selected the rc�cficalale method practicable an men ,quonfily.generator,I have rnad,s d good faith effort to min
<br /> and the environment;OR,J I am Q small Day Year..
<br /> available to me and',hot I can afford.
<br /> av
<br /> 0 Signature/,
<br /> ed/T d Nitme
<br /> ZMvnt Day Year
<br /> led anion!D.Re ei i of Materials
<br /> 17. Trans rter I Acknow Signature .X
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<br /> Printed/TYp.dVame
<br /> Year
<br /> If.A114 nth Day
<br /> LU S
<br /> P 18. Trans gnature
<br /> P, Acknow$edgement of Recei t of Mweriali
<br /> 0 R Printed/Typed Name
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<br /> R
<br /> 19. Discrepancy
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<br /> C
<br /> A ��ikq mars est ce,"t as noted in Item M Month Day Year
<br /> 7., .1 hazardous MOW'—' Is�r`red b this mard est ex
<br /> 20. Facili 0-nar or 0�eraior Certification c fec.01 5ignaturO L
<br /> Printed/Typed Name
<br /> Y
<br /> ELOW THIS LINE.
<br /> Do NOT WRITE B
<br /> Yellow. GENERATOR RETAINS
<br /> 'A (1/99)
<br /> 12
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