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;913 344 3614 # 26/ 33 <br /> 10— 2-06; 4:49PM;YELLOW <br /> t1,- /. <br /> I>s. SMt.of Colifornki. amental Prop hon Agehry <br /> L- PotmApp,.,IOMBNo;Q050-0039 IE piine9-30.991 SEC ItISfTUC110115 OD back Age 6. Department P balances Contr <br /> Plegss print or type. F.rm designed/or we on elite(12 prtchJ ypewnf.r Sacr.meNa,Cql ihrnia <br /> 1. Gdnerat.?s,U5 EPA ID No. Manifest D«ument No. 2. Page 7 In(oUrm9tic"in the shaded <br /> UNIRORM HAZARDOUS.•/e y is ndt equired by Federal areva low. <br /> WASTE MANIFEST - O { (� air <br /> 0 <br /> GsenaraW,Name and Molling Address t')phh . Ip� Y:4V G>O c`[vf A Stoti ManifeslDavmeN Number' y�� q <br /> ?, �a233 �QUMISJ• Pwf. ..807 <br /> o 9TD(;!(.W , Cb B Stale Ganeral.rslD <br /> t h 4. Gen«atnesPhonetUA1 01 <br /> N S. Transpnrbr 1 Cempaey Nam. 6. US EPA ID Numbm C.Stole Trahsponer's ID[Reserved.1 <br /> tn' <br /> D. Transporter':Phone( ��-�rr�•� /�s -�sr 0 <br /> a� 7. Transports 2 Cd �ony Nome 8. US.EPA IO Nambar E.State Transporter's ID fReserved.I <br /> _�r--Q : F. Tr porinr's Phone <br /> t e U 9 g orad F 101 Name ono Site Add.... 10. US EPA ID Number G` Sia Facility,ID <br /> ba i d4ID rydv�2Tfpt.( I I I 1 1 1 1 1 1 1 <br /> H� I(m3C) V�''I�-4'�'1 .l's"• H. Fcltys Phone <br /> a 1 C�NCs p,� +c_I.1 .cp Go81` 2-W5 L-5-445` <br /> 12 Cisowinem 13. Total 14. U t <br /> Q U. 11. US DOT Descript on(including Proper Shipping Name,Hazard Class,and ID Ntonk"I <br /> No. T pe Ouanlly WI/Vol I .Wasle.Num6er <br /> Cy a'1�� ASTM i w Ni T P-ELAT6-D m&oZ i,&L, Stale <br /> PG V 875, Ir 1 I 5 EPAl%b I <br /> f� Stare�I <br /> 1 N .R. - I^ tppW s I l9 +� 4 0 / a o l•` EP A10}II9Yo�l . <br /> A 1y Stoic <br /> T <br /> f R <br /> d. state <br /> W <br /> 2 a Ad: C R WF Maf n4 r[i Iqd Abay. R kgdfing sodas Far Wa lel UstadlAbave <br /> howl" k3 a b <br /> w 11"! ��'tr.(.'F"E;r.%'1 T�8'f215 �''i2.CSM�1•E'.l- J � a-CXo`j',� ' <br /> s <br /> O 15, Special Handling insl aafiaas and Add 1 I Infarmaha^ t} N t'-1 Y�t2Gk�JC <br /> I � q ae -'i'2.i•-2o3 S <br /> j 511.,.L- TO r( C <br /> d 16. GENERATOR'S CERTIFICATION: Ih,mbir deelar.that the conlantsof this consignmegfpmfully and accmma♦y descrihedabovebyproparshipping n.......ra dossifiedy poled, <br /> Vmarked,and labeled,and are M all respeps in paper csndiI,..far I.n,pad bby highwpy«cordiog to app11lcable international and national government regulotions. _ <br /> I J If I q a large quant'. '6. bio r,I lrfitythal I hwe a program'n pia e ro raducb Iha voleme and laniary of wpsle generated to the ddgrea 1 hove delmmined to he acuurrdeally <br /> W pore ncobl6and lh sol led a p�lactk.bl.method of treatment tomgerpr disposal correctly wailable to me which minimizes the prerem and(vhre lineal la home health <br /> nd the environ O if m,• sm quontily generator,I have made o good faith effort to minimize my wosts nor ion and selecl The best waste management method shot is <br /> �- available <br /> no <br /> t l< d <br /> Oy PrinNd/Typed a I S;gc.w,. Month Oay Ywr <br /> T 17.Tram rter o e emenl of Racal 1 of Mate iab w•r^"^""*n• <br /> I w s Printed/Typed NdIn +... •� 5 gnowre fy Monllt DaY Yevr <br /> P"S <br /> t m 0 18.Tram p.der 2".aneledorkent of Recei t of Materials <br /> T Primed/Typed Name Slgnvly a r; Mpnlh Doy Year <br /> W E / <br /> R <br /> 14. Discrepancy Indication Space <br /> Z F <br /> _ A <br /> C <br /> L <br /> 20. Pah or O orator Conificolion of r«ei t of hamrdous materials covered by This manifest except as noted in Item 19. <br /> Y Printed/Typed Name Signotura _ Month -Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DA.T5. <br /> EPA 877000--29 <br /> DISC 0Il/991 To; P.O. Box 400, Sacramento, CA 95812-0400 <br />