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S". of California—Environmemol Protection Agency <br /> Form Approved OMS No.2050-0039(Expires 930-991 See If1SIIOCIl003 Oft bOCIL,_AOBe 6. Department of Toxic Substances Control <br /> Please print or type Form designed For use an efife(12-pib pewrFtec Sacramento,California <br /> UNIFORM HAZARDOUS 1. robis US EPA ID No. _ anifw Document No. 2. Page 1 Information in the shaded areas <br /> / 11 is not rpuirad by Federal law. <br /> WASTE MANIFEST .. I .�� � U l 1 off <br /> 7. Generator's Nome and Mailing Address 1 F„ /t d,,y�rl , /f A. Sloh Manifest Document Number <br /> ,T��r s.� G P 99645442 <br /> 0 +� //F/d ) •,1G,'_ t/C1 8. State Generabi,ID <br /> A. Genermor's Phone 1 001 HO/ f ; 7 / ( Il( l-1 ) Z 41 I <br /> h5. Tnmr.pomr I Company Nome d. US EPA ID Number C. Stole Tron,pxtei s ID IRn .1 <br /> it-1E4 <br /> e5 .. .a r r .. . '.'3� �1. r• tT :: (' F! D. 7ramporlx's Phone $t1(l <br /> .i3 S <br /> m 7. Transporter 2 Company Nome por Imo_I <br /> p p y S. US EPA ID Number E. Sate 7rom Ni s ID Ra rued. <br /> f. Tmnspxbr's Phone <br /> � ptwlePANm,and Sih Address 10. US EPA ID Number O.AQ ,�MMiNStile fad iy's D <br /> V t ✓S L .S3 6 8 f <br /> At,FRlnhift lin <br /> � . . <br /> H. facility's Phone <br /> Nv 1s19.12 i J ) ? r3 n 3 5 702-$7 <br /> 7-9001� , � <br /> IMu 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Cori°ers 10, Total 11. Unit <br /> No. T a Ouentily Wt/Vol 1. Waste Number <br /> °- PION Of•f,A NA?AtttlryL1R wActir' t trri l!n State ?21 <br /> .EPA/Olher <br /> 3 c <br /> E� b.p N Sbro ' <br /> m E <br /> y R EPA/011ier <br /> A <br /> p T State <br /> a0 O <br /> R EPA/Other <br /> W d. -. <br /> Stab <br /> Z <br /> V EPA/Olhe, <br /> W <br /> ZJ. Additional Descriptions far Material,Listed Above K. Handling Cade,for Wastes Listed Aherne <br /> 2 L1RED OIL A WATER tfi b. <br /> W <br /> lie � <br /> Q <br /> Z 15. Special Handling Instruction,and Additional Information y� s S <br /> S. I Y ovi a ,r f. P 7V oAvef <br /> ZGLOVESso -, <br /> _ EMFFtt;FM*;v rlit»fE arm-rsf)� iiT+�� �u,.�,1,Grlsf+� G�1 <br /> t- <br /> V 16. GENERATOR'S CERTIFICATION: I hereby declare that the conlenh of this conigrent are fully and accurately described above by proper shipping name and ora classified,packed, <br /> IIIIJJJJ marked,and labeled,and are in all respech in proper condition kr transport by b highway according applicable international and national government regulations. <br /> I <br /> J <br /> 0 I on,o largeat 11 generator,I certify that I have a pop ram in place to reduce the volume and tacitly of waste generated to the degree I lime determined to be economicallyy <br /> N PracticableaPracticableth <br /> icable and Item I hove selected the practicable method al treatment,storage,or disposal currently available to me which minimizes the present and future threat to human heohh <br /> and the environment;OR,it I....Mail quantity generator,I have made a good fall effort b Minimize my woste generation and select the best waste management n,.1 o l that is <br /> O availabfe to me and that I can afford2,D I cry. <br /> y Printed/T me i Si4twbrs/ / ./ nlri <br /> W I 17. Tram 1 Acknowl h- of of RxJi of Materials 444 <br /> us j Printed/ dN MaSignature Mlpnik / <br /> f k lP ys/i <br /> O0 I8. Trans rer 2 Acknowl nl of Recei f of Materials <br /> RT Printed/Typed Name Signature Month Day Year <br /> w L <br /> 04 <br /> 19. Discrepancy indication Space <br /> Z F <br /> — A <br /> C <br /> 1 20. facility Owner or Operator Certification of recel t of hazardous materials cowered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DISC 0222 11/991 <br /> EPA 87700-22 Yellow: GENERATOR RETAINS <br />