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State of California—Environmental Protection Agency .Form Approved OMB No.W5Q-0039(Expires 9-30-99) See Instructions on bock 11of 'ge 6. Department of Toxic Substances Control Please print or type. Form designed for use on elite(I 2-pitch)_ r.vriWg • ` :. Sacramento,California UNIFORM DOUS 1 Generator's Us LPA ID N , Manifest Dent No.J �2. Page 1 Information in the shaded areas _ is not required by Federal law ANTE � ES`�F �CI_AJD ,91811'13 1)19 91_ 1 1 1 of .I 3. Generato.'s Nome and Mailing Address LODI t+fl?TAL TECF Z 982910273 V) PO BOX 957 LODI, CA 95241 t late Gener8tw s ID -- - Ln A. Generator's Phone 4,,509 1 334-25W FRP CALK( I N 3. Transpo�rt�er-�1 yCoom�paany Nname ir6. US EPA ID Nvmber "$late Transporter's ID 000 MIR ♦OPi7vi"Ony _._...—..__—.� o �VZCS A D 1 A 2 8 2 7 g g g �' Transporters PfaAa (91°611 372-2342--� o? 7. Transporter 2 Company Nome �8. US EPA ID Number State Transporter's ID QTransporter's Phone --- --_--- V 9. Designated Facility Nome and Site Address 10. US EPA ID Number 'YLL Stain.Facility's ID -: Nz _J3 A Q064611 7 Q H facility's Phone ss 9- o v _ Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and TB Number 12 Contain rs 1 ' t ld- 1 � OD ZN(J �/�} pP p�( A.�9�bP �PP 9� @ ♦ 1 No. Type Oua hr- Wt I. Waste pN,ummbe, ^� a. NO 11CiS21 HALd'Ll�tn S W1'M�iJ"+�-it4�D I state Lid. 4V .1.3� E.. 6 _ a 7 (EPAi Other `Vo N slate co co E O 1{a" ',EPA/Other v A — - O T �l Q state CD O - - co I2 EPA/Other Zd ...\11J _ State ----- —i w I I EPA/Other w M ifioT Diesci+pfons fa Materials Lisled A6cv ALTMATH-FACIL•�-.�+�J.a t: K. Handling Codes for Wastes Listed Above Z y 0 1� .r21• i 171 C.W.M.I. a. L Lu ERAN MILLS DISF. FACILITYWM �'� 3 Lu KETi Profile#E309 �f[F`A6 - k-'. ' FON 471, 4. 525 OLD CATWO646 17 O 15. Special Handling lostroctions and Additional Information i Q VM GKOM & PROTECTM faI'T S 213 �EI.I,Y S`r. Z 24 HR. 99M. # (209) 369-4583 LODI, CA w "^' J 16 GENERATOR'S CERTIFICATION: I hereby declare that the contents of this const rnent are fully and accurately described above by proper shipping name and ore classified,packed, Q marked,and labeled,and are in all respects in proper condition fw-transport by highwoy according to applicable international and national government regulations V J If I am a large quantity generator,I certify thot I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be econom'.III c- practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health N and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is available to me and that I can afford - OPrinted/Typed Nome Signotur Month!' Day Year Z / w T Transporter I Acknowledgement of Receipt cbWaterials _ ce R Month Day Year w ped/Typed Nome ' e N _tE Lu S t- P L, 0 18. Transporter 2 Ac nowled emenr of Recei t of Materials O R Printed/Typed Name Signature Month Day Year w E 'n R (aj 19 Discrepancy Indication Space t Z j, I t L""f �'7 it�I iF'So/cam f Gv r L4�tr�v.��C jQ�+•+ti c �'`` & f /C' 1 20. Facili Ow or O er or Certific f recei t o zordous materials covered b this manifest exce s n n Item 19. T Printed/Type ame Signature Month Day V i DO NO-f WRITE BE THIS LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. 4/97 (Generators who submit hazardous waste for transport out-of-state, DTIC 8022A 1 ) produce completed copy of this copy and send to DTSC within 30 days.) EPA 8700-22