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_ _ <br /> -- - <br /> star.of Cal/o o - ...y. m;P;or«rbr Agency - - - "-- - <br /> Form App o O z c 50-0039(E.ptres 9 30 99) <br /> Pf se pry t I yp r,designed for use-a.l,te(12-pitch), iter 'rJSee Instructions On back ' e b. Department of Toxic Substances Control <br /> f ,�I1 Sacramental California <br /> NIFORM HAZARDOUS e rP '7ry EPAUTc, Manik Doca3rt No./ 2. PogeJ nkrmafion in the shaded orev: <br /> WASTE MANIFEST i 4 <br /> is not required by Federal law. <br /> T ..n. ,s ! of <br /> .111s Name yrJd 21y{I rq r�s;ry A.State Manifest Document Number <br /> o V, . ,f CA 9 23354341 <br /> h 4 Ge a aror's Phone(`T'"��) 2 � ' :i� B. State Generator's ID <br /> N 5 Transporter 1 Company <br /> n Nam 6. US EPA ID Number <br /> CP Fsr r;'!'y - :.i.3?F.N ° i,> .`;pt:;: State Transporter',ID(Res=rved.11 <br /> o INC.tali: '�"_t <br /> D. Transporter's Phone <br /> m 7. Transporner 2 Company Nanta <br /> 8. US EPA ID Number E State Transporters ID Reserved.) <br /> Q <br /> V 9 Designated Facility Name and Site Address t E Transp ter'x Phone <br /> Q ,lU(}�,50 10. US EPA ID Number G. Statd¢jE iy�lp;$. i•} jY <br /> t, t'IfF`�t.Y2.d>E E�C;fS r'-.'1''i>(;533' 8% ; <br /> G"xs )[7.Ty H. Fadlttys.Phone <br /> Q 11. US DOT Description 9 per Shipping 12. Containers <br /> V pion(includin Pro Sht n Name,Hazard Class,and ID Number) 13. total 14. Unit <br /> Z u. No. Type Quantity Wt/Vol I. Waste Number <br /> = N l bdASTF ALCOR T. w r�, a, <br /> { ALIPHATIC AI.Co €ur' Stale ;sq3 <br /> G ON-1987 PG Za xt 1:;Iti :, F)M <br /> ERG# 1 2 j <br /> j N b. � � %...•, EPA/Other <br /> n <br /> n E State <br /> v R <br /> a A EPA/Other <br /> i T a <br /> a 0 State <br /> R <br /> e EPA/Other <br /> � d <br /> State <br /> 1 <br /> s EPA/Other <br /> Additional Descriptions for Materials Listed Above <br /> Handling Codes for Wastes Listed Above <br /> d <br /> 15. Special Handling Int cf ons and Add t o al Info m t on nn <br /> I "T4.1 fr3.L�. <br /> hSLBgi;°k tI,13rL <br /> ; k� ftiE k> 8Jv h6� L`�EL7{ µ jiPt) IF TJNDF71.IVERAE$E P !tIRN i0 6Efi'TR/iP( z <br /> K CGRP C7"FIC7t7T.ZED Ter REL"AIN I,TC:EL SFD SiJ8SWQ(JCMT CARRIERS AS NF;CESSARY. <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the c. tentsafthis Constgg mentor.fully and accurately described above by proper shipping name and are classified,packed, <br /> marked,and labeled,and are in all respects in proper condition far transport by highway according ro applicable international and national government regulations. ' <br /> If I am a large gvantiry generator,I certify that I have a proggram in place to reduce the volume and loxici f waste generated to the d j <br /> practicable and that I have elected the ppracticable method of treatment,storage,or disposal c ty e .gree le have determined to be economical)y <br /> and the environment;OR,if 1 am smell quantity generator,I have mode o good faith effort tominimize <br /> iToble ta me which minimizes the Present and future threat ro human health <br /> available ro me and that I can afford Y waste generation and select the best waste management method that a <br /> Printed/Typed Name Signature I' <br /> Month Day Year <br /> 1 <br /> F 17. Trans rte 1 Ack o led .moor of R t f Materiels s <br /> L Printed/TypedPJpme " <br /> II ) r,- Signabre Month Day' Year <br /> 78. Trans orter2Acknowled�ement of Recm tof Malerivls <br /> II Y Month ji <br /> T Printed/Typed Nome S <br /> R ignalere, <br /> T Day Year <br /> F <br /> 19. DiscrepancyIndication Space 9 <br /> A <br /> C <br /> 1 <br /> L <br /> j 20. Facili Owner or O rotor CertiFication of r«ei t of hazardous materials covered b this manifest except as noted in Item 19. <br /> T °- ",d/Typed Name 1 <br /> T. bug naturemonth <br /> Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> 8022A(1/99) <br /> 8700-22 c <br /> Yellow: GENERATOR RETAINS 2 <br />