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ShnP of CelRemia—fmimtmwkd Prolenion Agw:ry. . <br /> Pium'.ppro"d OMs No.20.30-=9(E.O .9-300) I-W Sea Instructions on backa 6.. <br /> Please print or".t Foran designed for use on Nit(121offi typewrlSacramento,li 8 Dapartmme'a Toni Subsancer Co., <br /> Smento,California <br /> UNIFORM HAZARDOUS 1. Gwwear's US EPA ID No. MMOR DewmaM No. •= 2. Page 1 information in the shaded areas <br /> WASTE MANIFEST <br /> 6l 41 is not required by Federal law. <br /> ' of <br /> 3. Cierimmor's Name and Meiling Address <br /> O <br /> us <br /> KOA KAMPGROUNDS <br /> A.%MLfisti + T MIIE.:RD. LOOT, CA 95240 <br /> 5. Transporter 1 Company Names 6. US EPA ID NumberA, I TED REM11I1 J <br /> f . <br /> Q7. Transporter 2 Company Name - 8. US EPA ID Number <br /> J <br /> 9. Designated srgnoted FaBiRly Nash and$i"Address 10. US EPA ID Number <br /> ENVIROPUR WEST <br /> 13331 N HWY 33 <br /> PATTERS11N. CA 95363 083166728 <br /> Z 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) 12. Ce^biners 13. Total 14. <br /> No. T Qua Wt/Vol s. <br /> a <br /> Now 901A <br /> I, <br /> > G <br /> v E <br /> qI N b. <br /> v� R <br /> 51 A 3 <br /> Tc. <br /> s R I I t <br /> • <br /> �I <br /> rd <br /> G F T• � .,e h s 1�i�'Nc <br /> n 15. Sacdnl Hondlinq b,Irucro s and Additional Informvnen -' <br /> )SE APPROPRTATE (PROTECTIVE GEAR <br /> OF.!;I(rNAT[D rACII.ITY EMERGENCY CONTACT 1 (800) 874-4444 <br /> c'MERCFNCY CONTACT a � ----- -- <br /> 16. GENERATOR'5 CERTIFIGTWNs IM g h Y �! M pP G <br /> horsefly declare Nset Ilne canlsres of the can nmam are fuT and a w,u l described above tr are r shi n name and ore clnsdfind, <br /> / pocked,marked,vid 1 Ybefed,and are in all respece,in proper esndh'en fa trunspi by highway according to applicable federal stare and;nhn notional laws. <br /> If I am o large n:,onr" genartnor, I certify that I ha v a pruprcm in place t reduce the w:ume and a.icity of waste girmi a the degree I have determined co be I <br /> I economically practicable and deaf 1 hose selected the practicdalu meshed of treatment,it"..or disposal currently available in me which minimizes the present and future <br /> Areal a human heahh and the"Anarn enh OR,;f 1 am a sma:l quantity aenertter, 1 haw made a good faith effort to my was" g.mwirron and sel tl the best <br /> was"in— ment method thus is available to ma and than s win off and. <br /> ), Printed/Typed Nome $ignanuro .. Memh Ovy fenr l <br /> I s <br /> 'I. / :': -,._.� . ✓'1 d:: ..•- �-�.,cr /l.Y ..i., . s r .7 ) I l 7 i.- 1cli <br /> t 17. Tran aver i Ar,:nowledpaoeM of Rettips of McNripl�. <br /> NPrinted/Typed Nam, SigeaMre ,M Dom, vnr-i <br /> _ , <br /> 0 18. Tam rte c :ave f of MaMiob <br /> ! i Printed/T d Name —_ <br /> e YPe �Sigraluro Month Day Year <br /> e <br /> 19. Discrepancy Indication Space „ <br /> r A <br /> 1 20.-Fwilmv Owner or 9"1111 Cv.tific receiet,of ardeus.rata aawred by•thio manifest ezc m ngtIjEt from IL9. _ <br /> T Prim"d/Typed Name -r- :pnavro ,.� nomh !lay Yia <br /> Y J <br /> /.• 170 NO rRiYF'BEt.GW 7HI l NE. <br /> TSC 8W2A (7/92) <br /> +a 879�22 . . Green: HAUIFP PF+AINE <br />