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Fo:myspproved OMB Neq 0-0039[Expires 9-30-99j eter : "�"" "'� - Sacramento,Cakitornio <br /> Please print or'type. Form designed for ase on elite(F2 pifchj 1y.. <br /> ' nerator's US'EPA 1D No. Manifest Document N— 2. Page 1 Information in the shaded areas <br /> kT—­UNIFORM HAZARDOUS is not required by Federal law. <br /> ` WASTE MANIFEST j tj3 ? j t! ? i� ph <br /> of r; <br /> A. Sest Document Number 2 3 7 5„5 �g 6 <br /> 3. Generatods Name and Mailing Address �hj{ `��tE <br /> UF1I_firad ;Iaster x �a l er73 :Atte-,." Pt ? -leri, ty <br /> r 5 Cpl' <br /> 0,,1 040 B. Sator's ID <br /> o 5200 Sheila 'St re`,t, C)a'fV&•rte <br /> in 4. Generator's Phone[ 323 j 254-a?70 state <br /> 6. US EPA[D Number O Sporter'.ID[Reserved.] - • <br /> C.t 5. Transporter 1 Company Name - .a.' <br /> m D- Ts Phone <br /> oaluz ?4at `atrans r Inc. C �3 1 2 3 U 0S. US EPA ID Number E. Sporter's ID[Reserved.7. Transporter 2 Company Name F.. T 's:P[+one <br /> a <br /> G' Sfafe Facthty s:lD ..r:.. <br /> Designated Facility Name and Site Address 10. US EPA ID Number x1F- h <br /> a Crosby & Overton. <br /> H Facility's Phone. <br /> Xao 1 630 W. 17th Street <br /> 0Ern Bch CA. 99313 IC JA ID 10 12 13 14 10 19 0 11 19 562-432-544 <br /> J 12. Containers, 13. Total 14. Unit ° <br /> Q <br /> U l 1. US DOT Description[including Proper Shipping Name,Hazard Class,and tD Numbed No T e Quantity Wf/Vo1 I::Waste Number. ; <br /> State.- <br /> a. 7 . <br /> � (� '�sorbe��at/ciies:�.i/oa:L) . <br /> s - 1 P EPA/Other <br /> 3 G ilT^- ?� s'i ��. r� '''a�7 q:T X11 <br /> E <br /> State . <br /> o N b. 343:`'`.° . <br /> m E �'M V.Ct'. A:'s 0 01-,x":f •. ',At 1�ZT,+ e 2„1 f TYN1 51D, .e) IN P EPA/Other <br /> v R r ?l <br /> A State lk. <br /> C. <br /> F V��. <br /> tj <br /> R � State <br /> LU d. v <br /> W }� E» +�aLoT3�r-ts �I.Ur�'1;0'Q .1 ri, 179? s-'. _r. r.i 14�:. <br /> f t / iso >v EPA/Other <br /> v <br /> u.l . . <br /> l: K. Handring Codes for Wastes Listed Above <br /> Additional Descriptions for Materials Listed Above , <br /> o a. ? absorbent/diesel/oil - Profile r'5119:3 a b. <br /> b. ) aerosols - Profile 951192 <br /> Uj <br /> c., ) absraz+*nt/acid - Profile #51195 d- <br /> Q 1 ' <br /> O 35. Special Handling Instructions and Additional Information /,d - <br /> ! JO' `:±'i toe !3t07-'rtrta Faci ty <br /> = ov, i 3to ctan, CA. 9.5215 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are Fully and accurately described above by proper shipping name and are classified,packed, <br /> Umarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and notional government regulations. <br /> If I am-alarge quantity generator,.I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degeAJ(lave determined to be economically <br /> p practicable and that 1 hove selected the racticobI.rgethod of treatment,storage,ar disposal currently available to me which minimizes the present and Future threat to human health <br /> v� p <br /> and the environment;OR,if I am a small qudnfity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> a available to me and that I can afford. - <br /> O Pri d/ ed Name -Signa •/ Month flay Year <br /> w T 17. Trans rter 1 Acknowled ement of Recei t of Materials <br /> p ` = Month Da Year <br /> a h Printed/Typed Nr- <br /> LU <br /> Signotu Y <br /> :E � � � <br /> LL. p 1 B. Transporter 2 Acknowledgement of,Recei t of Materials <br /> O R Printed/Typed Name Si nature Month Day Year <br /> S <br /> t3.t E <br /> cn ..R <br /> V 19. Discrepancy Indication Space <br /> YZ IF <br /> A <br /> C <br /> 20. Facility Owner or Operator Certification of recei t of hazardous materials covered by this manifest except as noted in'Hem 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> Blue, GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DISC 8022A (1/991 To P.O. Box d00, Sacramento, CA 95812-0400 <br /> EPA 8700-22 <br />