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Slate of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9.30-99) See Instructions on back of " e 6. Department of Toxic Substances Central <br /> Moose print or type. Form designed for use on elite(12-pitch) iter. Sacrament,California <br /> UNIFORM HAZARDOUS. 1. Generows Us EPA ID No.. Mam es f Dacumen No. 2. Page 1 InForma ion in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST A 3 10 12 11 11, of <br /> 3. Generatoyrx NName a+n�dLMaziling Address ,// (r A. State Manifest Document Number ,yry1 qq�. <br /> s �,�J /'/6/ � a7~iY/G= C/sv 2{ °4 `°J 0 q } } <br /> 3.a s �'1,1 <br /> ps 1, Slate Generator's ID <br /> W1 <br /> 4. Generator's Phone <br /> cv 5. Transporter I Company Name 6. US EPA ID Number C. Slate Transporter',ID[Reserved.] <br /> h <br /> 6 MORGAN ENVIRONMENTAL SERVICES IN A T 0 8 0 0 1 3 9 2 I D. Transpaners Phone <br /> 0 55.0 26l-0134 <br /> T *7. Transporter 2 Company Name B: US EPA ID Number E. Stale.Transporter's ID{Rese d <br /> �93BG9563 <br /> CMa CONSOLIDATED WASTE iND. c A D 9 8 3 6 6 8 5 8 3 F. Transporter'sPhone (514)Fs96-1684 <br /> /tea V 9. Desi n d Faciliy�a�me�and Site Address 10. US EPA ID Number G.Slate Facility's ID 1 <br /> V D/K VIRONFiENTAL <br /> C:)Z 3650 EAST 26TH ST. H. Fadlity's Phare <br /> �0 VERNON, CA 90023 C A T 0 8 0 0 3 3 6 8 1 (323)268-5056 <br /> 0 Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No Co^gainers 13, Tobl 14. Unit <br /> V No. Type Quantity Wt/Vol I. Waste Number <br /> NZ a. RCRA HAZARDOUSWASTE SOLID state / <br /> F 4Pf1 <br /> 3 G D P EkCRA <br /> E b. State <br /> o N <br /> m E <br /> R EPA/Other <br /> v A <br /> o T stage <br /> O <br /> _ R EPA/Other <br /> of <br /> W d. Stage <br /> Z <br /> W <br /> U EPA/Other <br /> w <br /> Z Additi a pjscrip]ior1s for RcV,jq��jlfted t�q t1•:L A.f?.rh fT vpnt:8l.TIf:X'fY L';.kt.G,.71 K. Handling Codes For Wastes Listed Above <br /> O 7 a 6. <br /> W <br /> d <br /> J <br /> OYiF:epi°11f1s1lliLgldAdd4kY94tL"�"1"9b4 EQUIPMENT <br /> Z 24 HOUR CONTACT —TOM MORGAN 510 267 0134 a) LRG/171 <br /> H <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are Fully and accurately described above by proper shipring name and are classified,packed, <br /> Umarked,and labeled,and are in all respects in proper condition for transport by highway according to app licable international and nalionaPgovernment regulations. <br /> J 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 economically <br /> o_ practicable and that I hhave selected the practicable method o treatment,storage,or disposal currently a. i1 ble to me which minimizes the present and Futare threat to human health <br /> and the environment;OR,if I am a small quantity generator,I have made a good FaitB a N m' ime y waste generation and select the best waste management method that is <br /> ac <br /> O available to me and that I can afford. <br /> } Pringe ype am ` SignaNr Month Day year <br /> Z ✓ at 1 I O <br /> Kw T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> ly Printed/T edNa /�-� Si nature nth DL Year <br /> W 0 I B. Transporter 2 Acknowledgement of Receipt of Materials <br /> O TR Printed/Typed Name Sigrature Month Day Year <br /> w F <br /> � R <br /> V19. Discrepancy Indication Space <br /> Z F <br /> — A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DISC 8022A(1/991 Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 8700-22 To: P.O. Box 400, Sacramento, CA 95812-0400 <br />