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<br />See Instructions on back of 06V46. Dawt.1Toxic Sabm
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<br />ease print or ype. form n,rcm
<br />1. Generators US EPA ID No. Manifest D.... IN.. 2. Page 1 Information in the ahoded areas
<br />UNIFORM HAZARDOUS 1 is notrpuired by Federal law.
<br />WASTE MANIFEST CAR 0 0 0 1 4 9 8 9 8 2 0 5 aF
<br />,_G..erp, kNomcxlMing Aadr.aa Site Address A. Slew Man,Fes, Document Number 23324057
<br />L7a0t0A, kDsPENDENT� 94 62 1 RO S
<br />OAKLANIND EB. Stow Generator's
<br />4. G.ne.tar`s Phone 1 510t639-7191
<br />5. Trcnspamer 1 Company Nome 6. US EPA ID Number C. StaeTranspomsr's Io l�.l 0539
<br />Orth State Ruvironmental 0 6 0 7 D. Transporsai s Pho
<br />550)598-2839
<br />7. T.nspadw 2 Company Nome 8. US EPA ID Number E'. $taro i.roporNri ID (Reserved.(
<br />Rust and Sons Trucking C A D 9 8 1 6 3 4 1 1 6 F. Transpanera PliaJ 610443-"93
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<br />9. 0.si nmed Facllty Name and Sot Addrms 10. US EPA 10 N.; O G State Fxdiy'e 10
<br />3P1aai�liacstRe Source Recovery C D 0. 0 '8 2 5 2 4 0 5
<br />LosOAn at, Pico soul WSS23 H. Faduy
<br />eo C A 0 0 8 2 5 2 4 0 5 1f499-7144
<br />12. Containers 13. Total 14. Unit
<br />11. US DOT Dmcripsion (including Proper Shippi,g Nome, Hazard Class, and ID Numbed No. Type OuanSty Wt/Vol 1. Was* Washer
<br />S,a931
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<br />PRINTING INK 0 M 0 G
<br />G 3, UN 1210, PG II �OQ , EPA/0101
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<br />tsweet. CORY K. Handling Codes nor Wastes Lined Above
<br />`1. Addi,ianvl Descriptions Fw Maroridi lisredAbave
<br />j 'A: 24010155 129 a. '. b.
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<br />j 15. Special Handing Inwuc6onr. and Addirional Information mer$eACy OA C
<br />RAT.REN 510-639-7191
<br />TV. 1 sildaseec 90 e. spruce Ave., South ten ytannlsoo, G 94080 a: IOX1ST b;
<br />Teas 2 addtsesc 15353 Old By Sha, S1 Cajon, CA 92021
<br />. 16. GENERATOR'S CERTIFICATION: I6 ... by declare lhatthec mnIneof this consgnmen, -n-hilly and accura d .... bed.6.6ypropershippingnameandareclassiFi d,paclsed,
<br />marked, and labeled, and are in all ..space in proper ...dnian far mcs,rr by highwoy according ,a appmabl. intemaroml and n°t�oaal 3e.ernmem regulmia,u.
<br />IF I am o large quonliy ge,rraer, 1 v ily hail hove a prop.. in place to reduce t0 volume and toxicity of Wass. generated ro t0 degree I hove determined ro be aconomicallyy
<br />i praai.ble and that To.. selected the practicable method o treatment sroroge, or dispwol currently aildble b an. which minimizes the presem and (vwa threat ro human hedth
<br />.ad the environment; OR, iF I o mall quantity gweramr, 1 have made °good faith effoH to mini my ..she generation rod .lea 8m best waste management method that is
<br />available to me and that I can oHard.
<br />Primed/Typed Name [ I r� n (, l�A j �� SignaNn - Month Day Year
<br />ALA \ Uu lUi D 2 Ci
<br />iT 17. Trina oner 1 Acknawld emento1 Receipt of Materials
<br />pPrinted/Typed Name eek y � r,- - Sign°era ko Y �e° _
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<br />UI S. Tram mer 2 Ack wleclamen of Receipt of Materials
<br />R Printed/Typed No • 51gnaturn Month Day Year
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<br />j19. Discrepancy ladicatian Space
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<br />20. Facility.r ar O rotor Ca tiCe°tion of receiptof h....coats anc iab covered this mani6,1... t as noted in item 19.
<br />T Primed/T nSignaen Menwh Day Year
<br />S r C,0La
<br />DO NOT WRITE BELOW THIS LINE.
<br />Whirs: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS.
<br />DTSC 8022A 11/991 To P.O. Box 3000, $peramento, CA 95812
<br />EPA 8700-22
<br />P
<br />DO NOT WRITE BELOW THIS LINE.
<br />Whirs: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS.
<br />DTSC 8022A 11/991 To P.O. Box 3000, $peramento, CA 95812
<br />EPA 8700-22
<br />
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