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<br /> 1. dote of California—Endronm meal Protection Agency
<br /> Form Approved OMB No.2050-0039(Expires 930991 • See Instructions o0 gaol(0492 6. Department of Toxic Subsfonaar Contra
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<br /> 1. Gerierctc,a US EPA ID No.. . Manifest Document No. 2. Page I Inforeac In n Iha shp pd-,.
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<br /> UNIFORM HAZARDOUS, y Is net rewlrad by Federal lea -
<br /> (, WASTE MANIFEST f: A / } (� 3 . 5 I
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<br /> 43. Generator's Name and Mailing Address a s /c S 3 ✓ (° 'Awl,
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<br /> h5, Tron"rh r I Company Name 6. US EPA ID Number
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<br /> l 9. t «rl' Nome and Site Address 10. US EPA ID Number
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<br /> p VERNON, CA 90023 C A T O H 0 0 3 :3 6 H J. �:..
<br /> ©� 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Container, 13.Total74. Unfl 1 +^•?` ;{
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<br /> ' 16. GENERATOR'S CERTIFICATION: Iheroby dedaro that the cnnlenla aF Ibis eansignm.nlaro fully and ec<urakly desaibad above by proper shipring name and afs dapiHed,padad,
<br /> 1 Q marked,and labeled,and are in all respects In proper condition for transport by Hlehwcy according to of, internolional and walorw government regulations.
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<br /> a large quantiy ge....ter,I car ily that I hwe o p ram in plow to reduce the velums and toxicity of waste generated to the degrees I have determined to be ewmneiwlly
<br /> practicable and 81st
<br /> IT..selected the practicable method of treatment,storage,or disposal cumnlly itpble to me which mim n;z.o Iha presem and Fubrs threat to Kamm health
<br /> and the environment,OR,IF I am a small-quantity generator,I have made a g«d faith effort b m'nim a p(y wrote generation and select the best waste manogionem method that is
<br /> av available he re.and that I can afford. //
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<br /> Prim am Signator /� Month Dny Year
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<br /> ��F[auL�1 1 17. Trans der l Acknowled men)of Receipt of Materials r
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<br /> sae 0 18. Transporter 2 Acknowledgement of Receipt of Materials
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<br /> V 19, Discrepancy Indication Spec.
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<br /> 20. Facility Owner or O orator Certification of receipt of hazardous materials mvared 6 this manifest except as noted in Ilam 19.
<br /> T Print.d/Typed Name Signature Month Day Y.or
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<br /> DO NOT WRITE BELOW THIS LINE.
<br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS-
<br /> DISC 8022A(7/991 To: P.O. Box 400, Sacramento, CA 958120400
<br /> EPA 8700-22
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