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j�rf;rni�'--Ere,ronrnemm Protection Agency - See Instructions on of page A. i,Irfovmt of T ic s B fp
<br /> . { d OMB No 2050-0039(E p nr 9-J49 Sacrament C 1'4c �_
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<br /> ri Gc orator's US EPA ID No. Manifest Document No 2 Page 1 I,Fo ohon m the shaded ore s
<br /> UNIFORM_HAZARDOUS �nat reqs red by F�. nal
<br /> WASTE•MANIFEST � -7 �� ' 1 of ---
<br /> A Sate M fast Doc tmcn5 N� r • r
<br /> 3. Gene to Mailing
<br /> Name rid Address -
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<br /> -11111TIP
<br /> 11 '!` UDI, CA 95240 I B. ,ai n..raia;.ID
<br /> a_Cenerptar's Phone
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<br /> 6. US EPA ID Number C. State Transport's ID 7 d,
<br /> 5. Transporter 1 Company Name _
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<br /> ( [ 4 4 Q ".31512
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<br /> j115-,371
<br /> J v '- 'I�'`� 1 1'D�'i"--- 8. U$EPA ID Number E Stato ronsportrr's ID
<br /> Q7 Tr nsponer 1 Company Name
<br /> _U I _ _ I I F Trans orter s Phone
<br /> Q 10. US EPA ID Number G State Facility's ID
<br /> 79,
<br /> Des gnat d Facility Name and Sitp Address
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<br /> Saco.,l andling nst uC'or s and AddP.` gal nl r rn
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<br /> R,13, ll5C STA;'AlilrJU SAFETY Pi2EL,1U fl:u:i.
<br /> 371-2570, 800-456-7745LW
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<br /> Kat 16. GENERATOR'S CERTIFICATION: I herebydeclare that the cormenls of the consignment nre fully and accurately described above by proper shipping name and are classified,
<br /> r .R packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international laws.
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<br /> If
<br /> I am a large quomity generator, I,certify that 1 have a program in place to reduce the volume and tonicity of waste generated to the degree I have determined to be
<br /> J economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future
<br /> a I mot to human health and the anvi,re,ret; OR, if I am a small quantity generator, have made o good faith effort to minimize my wosM generofion and select the best
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<br /> � waste mono "merit method that is available to me and that I can afford. MoMh Day �Y/e<
<br /> Signature /
<br /> 01 1 tri tqdfryped Nam - � _ '�,. � ��, 1, � �, `� �•
<br /> U I I 1 17, T sooner 7 A k o ludaement of Recei f of materials
<br /> n I P inted/TypedName / - Si a Month Day I'.Yen
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<br /> o 1, IS. Transporter 2 Acknowl d t of Recei t of Materials
<br /> Signature Month
<br /> w a F Printed/Typed Nome -
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<br /> ! 19. Dlsciepuncy Incitation Space
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<br /> . Fa t, O _r o C e,ts or Cent tion of receipt of hazardous materials covered b this manifest except as noted in been 19.
<br /> 20 - Month Day Yep
<br /> - Signature I- !
<br /> Printed/Typed Name
<br /> DO NOT WRITE BELOW THIS UNE.
<br /> Blue. GENERATOR $ENDS THIS COPY TO RTSC WITHIN 30 DAYS.
<br /> To: P.O. Bon d00; Sacramento, CA 95812-0400
<br /> pT < B 21. 111,'91) _ __ - - n^s r 7{.•,;'.li
<br /> '._ EPI E7D,. 2z '1 ill:a.IA I .:a.�ti�nt 7Jit1'Sik7i° z4 f,,ht
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