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,tate c7CalNomio—Environmemo1 Protection Agency <br /> "one Approved OMB No.1050-0039(Ezpirw 9.30.94) 'V Seo Instructions on batt( of 1 p b. DepartmeSubstancesof Toxic Substances Control <br /> 'lease print or type. Form doa rurd for use an e81e(1lplich)ypew4ft, � Sacramento,Califomia <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST (.1 Aj I)l 0 9 'i f, !11 141 P1 61 S' 1 ,S 9 of 1 <br /> 3, Generator's Noma and Mailing Address <br /> R.V. I'1RI:UIIIi, INC. <br /> 1 916 S0U1H Cl-INTER !AMI I <br /> 9310CKTON, I;A 95iP06 S+aeC rend ar sib "; <br /> 4. Generator's Phone ( 2091 464-4561.' ATTN: ART SMITH N �# Q ff °"Fy`8 31 7 <br /> a <br /> j S. Transporter 1 Company Nome 6. U$EPA ID Number SMk TsarojloAds'rIfY <br /> G s, `Tram orter'sPhone -s �., �. <br /> - GRFAT Id( f F'HN CHI I I:AL , C(1.. C 11111191 H I .i H t' 4 4 .+ �, P f l 09198i�_'S'Jfi1 <br /> 7. Transporter 2 Company Name S. US EPA ID Number 'L State ironsporter's III <br /> i <br /> �f. Transportcr's Phond <br /> Q 9. Designated Facility Nome and Site Address 10. US EPA ID Number Y " <br /> 3 CA CI$_MICAI_ /DIV OF CF' C:HEMICAIf! <br /> 9851 DICT RD <br /> a SANTA I'F SPRINIG5, CA 9067" 11:1 nj 01 ()1 ol 0 111 111 1,41 01 it S <br /> J 12. Cannabis. 13. Total 14. Unit <br /> Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. T e Quantity Wt/Vol <br /> L a.RO WA:s I I til KAI 1 N1 if I IRUII,.I fl 1 I H413 i -a. <br /> (AMMONIUM HYDROK f Of 1 )'/. ; s 10R101i0 VI MAI I(i lAl . <br /> G NAI%19 t D002) ( F G <br /> j E FRG # 60 <br /> n N Is. <br /> E <br /> R <br /> A <br /> T c. <br /> O <br /> R <br /> L <br /> Z d. <br /> J <br /> w ' <br /> Z AbOvB nit, Ha :1% <br /> Oi F, R 12X1 ' <br /> n <br /> 0 R <br /> nwwww��� <br /> a �I <br /> 1 .1S. spaciol Handling Instructions and Additional Information <br /> C fJEAR I'R(lPfI? PROTECTIVE CLOTHING, GLOVFfi AND GMf;L.E'.i. <br /> Z F.MFR(-,FNCY PHONE NO. (313)A44-5626 <br /> w <br /> x <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment arc fully and accurately described above by proper shipping name and are classified, <br /> Qpocked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international lows. <br /> U <br /> If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> 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 /> Nthreat to human health and the environment;OR, if I am a small quantity generator, I have mode a good faith effort to minimize my waste generation and select the best <br /> waste management method that is available to me and that I con afford. <br /> O Primed/Typed Name Signa ur. 011 b fid 1 f O f Monti Day Year, <br /> - _ 1 - ice c;�,�.-. R.V. ( IR171( I'S, INI', 1 1 j I i <br /> U T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> Z • <br /> � • Prinlad typed ante Signamr Month �7 Yeor <br /> W I <br /> f o I8. irons Mr 2 Acknowled .mem of Receipt of Materials <br /> W j Primed/Typed Name Signature Month Day Year <br /> Oe <br /> W 19. Discrepancy Indication Space <br /> 4 F <br /> U A <br /> Z C <br /> I <br /> L <br /> I 20. Facility Owner or Operator Certification of receipt of hazardous materials covered b this manifest except as noted in Item 19. <br /> T Printed/Typed Nome Signature Month Day Year <br /> r <br /> DO NOT WRITE BELOW THIS LINE. <br /> DISC 8042A (7/921 <br /> EPA 8700-72 Yellow: GENERATOR RETAINS <br />