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Oct 03 02 11 : 47a RIC 209 234 2711 P. 10 <br /> $let.of California—Esnu.amantol Prolodion Aganry <br /> Form Approved OMB No.2050-0039(Expir.a 9.30.991 See Instructions on back of page 6. Department e1 Toxic Substances Central <br /> Plea.P^m er typn. Farm 9.atinnd ler me an ehho f ISpdahJ typ.wdlar. <br /> Sacramento,C.Bfamia <br /> UNIFORM HAZARDOUS I. Genarocsr's US EPA ID No. Manifest DecumenF No. 2. Page 1 Information in the shaded areas <br /> is WASTE MANIFEST - nal rc,ai,.d by Federal law. <br /> ..e. 11410-101111101011 i.. l j 5r. rd of I <br /> 3. Generator's Name and Mailing Address A, $1.1.Monifotl Document Number <br /> tar:vAnLcls:t)Ie LL)I Ts�l�l_ r,:c>n:T�r-)t:r;: <br /> 21928491 <br /> 0 <br /> L:ot)iN01-Is IT{W.61_VI), Sl'0('Kl ON,C:& 95e9Ly.: B. Stab G.mmaxu',ID <br /> lal, 4. Gxrm,.I.'s Phone I V@47.142j`00 fd6t: 611. .Y EXT. 227 <br /> h5 TmmP+nnr 1 Cnmpeny Nome 6 US EPA ID Number C. Stet.Tmn",soe.ID rit—ml I <br /> c ` D. PheaRnnFoFrr ironmental Sol e '916 331-5743 <br /> c� ]. Trae.pornr 2 Company Nome B. US EPA ID Number E. Stan TramporNrs ID fReaera.d.I <br /> F. Transporter'.Phone <br /> "r 9. Desigpalgid Facility Name and Site Address 10. US EPA ID Number G. Stals Faciliys ID <br /> :tea 09C F'ITNIraf11T1Ci5t.A1 <br /> Z K7L'tE)i_. :}f:i:iT. '>t. <br /> t"\v w .y H. Facility's Phone <br /> o vicelnoit, GA EMMI 3" �' k,19 ;) R 323-268-X056 <br /> __12 Containers 13. Triol 14. Unit <br /> 1111. US DOT Dmvipti.e liecludmq Pro,.,Shipping Nome,Ilazord Class,and ID NembeH 12. T 13. Tota IA. Unit <br /> I. Wavle Number <br /> I.\V= Nmi RRA RAward,�u4; Wilsto : fIo id stat. 781 <br /> 3 G 81'NNl� PAIM) [RCT00f 171 EPA/Other <br /> E s C_ Iii M . hiCTN-ItCP,A. <br /> r L Ston tad <br /> N ricin - RCRA Hazardous !Wastes liquid (Detergetd) <br /> m E EPA/Other <br /> n R F!lGJt'17 1 1 (� G hlun4acr:r <br /> V A a <br /> o T Satre <br /> m O <br /> EPA/Other ' <br /> Fd. Stare <br /> Z <br /> W <br /> V EPA/Other <br /> w <br /> 1. Additional D>escripJrio's far Materiel.Listed Abwe K. Handling Codes kr We,%,Listed Abwe <br /> 0 a 116J 3ycSS <br /> as, a d. <br /> iflog'Zea? G ' <br /> 0 )5. rilliHkgqclg{nptf,�cfi,yµwd,Addidlonal Information <br /> Z 74 Hr?. F;,nr_R rW.V CONT:''+L_1` 91G-3'/:.. r97 d)t Ignhaj <br /> 950 It'll)t f,SI IAN FILM-)., 45FOCKNf ON, C.A., 95200 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents oNhiscansigg tat are fully and accurately described above by prapership i.g name and are clmsifiad, eked, <br /> Umarked,and labeled,and are in all respects in proper condition for transport by 6ighwny according to appl icoble international and WinnePgovernment regulations. <br /> i_ IF t nm largeq—Ii y gon....."I certify the,I hwe a proogg n in place to reds.the vol d toaiciry f wmt.g e ted to 16.degre.I hev.determined to be ecanemicolly <br /> w proc6ca61e and that 1 ave selected 8u predicable method at Ir.unumt,staraga, diapas loris�tt�y owmlo6l.to me which minimizes the pr eml and future Ihreal to human hvallh <br /> and the enviranmenl;OR,d I am a small quantity generator,I ham made o good faith ort to nihil' a my was le esneraliobor�d select the best wash management method that is <br /> 0 vmlable n ma and that I can afford. / ''t <br /> T Printed/Typed Name Signore.✓ t - Month DAY Year <br /> Z / 2 <br /> ED RWT 1]. star t Acknowlad I R.c.ipt I Mabrtal. <br /> w Printed/TYPed Sigr. Month DaYear <br /> Y <br /> P <br /> i OR 18. Trans rter 2 Acknowled emenl of Reui t of Materials <br /> T Printed/Typed Nome S' nature Month Day Year <br /> � w E <br /> sQri R <br /> V 19. Discrepancy lndimtion Space __.. <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> I: 1 20. Fa,ili Owen or Operator Ceniiiocion of rte of Imemd.us me,mlals c tared b IM. nihnl tea t w tamed in Item 19. <br /> T Printed/Typed Name SignaNm Month Day Year <br /> Y <br /> I <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/991 Blue: GENERATOR SENDS•THIS COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 8700-22To: P.O. Box 400, Sacramento, CA 958120400 <br />