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npr 10 03 00: 40a Prefe—red Customer 209—GGG-3000 p. 2 <br /> Stole of Califernip—fnviranmeatol Protection Agency *ems <br /> form App,and OMB No.2050-00391 Expires 9-30.991 - _ _ See Instructions on back ofrage 6. Department of Toxic Substances Camra <br /> Pleam print or . form assigned/cruse on sMtj!$•pilehJ yp@witer. sacromemo,CaGlo,nia <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No.. Manifest Documml Na. 2. P.O. 1 Iniermalion in Ph.sh.dd areas <br /> is not ngvind lo. <br /> WASTE MANIFEST L t by F.derel U �� of 1 <br /> 1 3. G.w.lo/s Name and Mailing Address I r RT11� 1�C PE 4 :A.,,State Manflest Document N.m6er^^.Z O ^O ^ <br /> LW Li N.'8rueda FVL LL f/ U Vh <br /> O B..s.ate Gbnvalefs ID <br /> UP) 4. Gnnararors Phone J`y/r,59•12)2, ✓Z `,/ <br /> (4M 4 95.222 <br /> N S. Transporter 1 Company Hama 6. US EPA ID Number C. StateTransporter's ID IFe,.rvvd.I <br /> m <br /> AM.C.M :AN VA'LLCY WASTE 011. A L 0 0 1018 2 7 7 e D..TraMporher's Phone 800-7'y <br /> 7. Transporter 2 Company Name . , 8, US EPA ID Number E. State Transporter's to lReserve .1 <br /> J <br /> F, Tronaponefs Phone , <br /> 0 V N Ppigbalal l!"li0•0m.4- MII0,0drle l( 10. US EPA ID Number G. StatCPar,�IyLIDO U V '! l7 .{ 7 fi <br /> 7'-ti0 (,''• AU9 ROAD <br /> � � !•:Is✓E;i!1/1 is�'�Is. . C,'A L:)307 n T H. F.,11�a phone r <br /> ,v O A L 0 0 0 1 3 ) z 'I F cJs kii ;les}is <br /> 'Va . nb <br /> V 11. US DOT Description Ilmdudingr groper Shippirg Name,Hazard Class,and to Mutineer) 12 Ceinea 13. Sobl Id. Unit <br /> Ne. T • <br /> Quantity WI/Vol I. Waste Number <br /> z MONAiCRA f-3AMMOVS.>.41ASTE UQUIO State <br /> 3 G {01V WATC'R ) 00 1 T r r G EPA/O r , <br /> J <br /> N <br /> So E .. - <br /> N R EPA/Othsr <br /> A 0. Stale <br /> d T <br /> O <br /> R EPA/Other <br /> sial. <br /> z <br /> w <br /> V EPA/Other <br /> w <br /> z <br /> J. Addition l Dxcripllons for Materials EINed Above K..Handling Code,for Wastes ListedListedAbove <br /> OILY WArri: . ,)i I,.Pr <br /> . <br /> C; a, <br /> Zie.-.... , <br /> 0 Is. Special Handling Inakudiona an Additional Information <br /> a <br /> Z CMC'I;^,ENry IyNOF}E 2U 7•GtS7 fSR67 " <br /> W <br /> F <br /> U 16. OENERATOR'S CERTIFICATIONS limeby declare that lhant <br /> eu .nb of Ibis consignment«eFully and occuratelydm « <br /> cri6ed above by Prop.,shipping name packed, <br /> ro lsod'surd labeled,and are In all respects in proper condition for transport 6y highway according to opplicabb intornotlarol and notional government regulations. <br /> t <br /> If 1 om a large quanti generator,I certify that 1 have a pro tam in plan h,reduce the volume and faxiciy of woJe ge me a ed b rhe degree!have dWrmiwd ro b..wnomieolly <br /> N pro cable and that I hen selected the proclica6le method a�treatmenh storage or di".wl cumntly mailable to me wF,ich ninimi:o the pr.nnt and future threat to human neabY <br /> and the eavbonmsm;OR,if 1 am a small quantiy generator.I haw made a.good falth•Berl to minimi.my w0,10 generation an ect the best comb management method that is <br /> 0 available tome and that I can o9c rd. r <br /> N Priptd/Typed Nome Signature - t ' 1 Month Day Y <br /> i J ! r,� ;.'�7t -f= 4.1�,L r ,P rbc G <br /> W T 17. Trcm,po,ter 1 Acknvwl.clemw of Receipt of Materials I• 11• " <br /> � t", Prl/nt�d/Typed N me / Signal. r '•.. Month Dom Ye« <br /> W 0 16. Tronsparse,lAcknowled amen f R•cei t of Mebriab <br /> 0 j PrMl.d/lyp.d Name Signature Month 1 Day Year i <br /> 19. DLcreponcy Indication space . <br /> Z F <br /> _ A <br /> C <br /> I I <br /> 20. F."I*, Own r O .rater C.rliil inn of ncei 1 aura;.,malmia s cevmd tis manifest.xcs l abed in Item 19_� <br /> TY Slpaalur Month <br /> th /Do yeorS, <br /> DO NOT WRITE CELOW THIS LINE. <br /> DTSC 8022A 11/99) - Groun: TRANSPORIER RETA11v5 <br /> EPA 8700-22 <br />