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r A <br /> 'St", of Cohfom En -an eat t!Pro". krm rigency P. <br /> /1'1`r`"• "' ,� �- g <br /> form Approved 0M8po.2 39�'xplrer 9.10-94) -'t Seo Instructions on back � -)age 6. � Deportraent of Toxic Substances Cont <br /> Poeoux.1itrl,tjr e. tvtm dvtglwd for 44 an eche jw-pilmy ik+r, Z Qj Sacramento,CwUiomia <br /> C,ertcrator's US EPA ID No. Manifrrst Docv:tsen i.� 2. Page I Information in the shajed areas <br /> UNIFORM HAZARDOUS is no?required by Federal law. <br /> WASTE AAAMFEST C_ ,'t I T 10 10 0 3 b 3 7 of 1 <br /> 3. Gwierater's Noma and li Address a ' <br /> oI <br /> TE:QRO ft'ct'IIPPC , MAnK.CTiNu z SUPPLY <br /> v1 I <br /> 2:-`0-3 NAVY OR'VE <br /> in <br /> r• SiOCKr(j' 4. CA+9,)0d <br /> 4. Generators Phone t C 9) -4o6 13800 <br /> r 3. Tronsporter 1 Company Nome 6. US EPA ID Number <br /> E�J:CKSO`4 NC. <br /> I IC IA Ji�' 10 1G p 1.4 ji_ It, 1314 12 <br /> 7 Tromporter 2 Company Nnme 8. US EPA iD Number <br /> ZII s Designated Facility Name and Site Address 10. US EPA ID Number <br /> 1 CAMEq(;,N YAKIMA. <br /> P 1414 '-TI?S` STRC_ <br /> l YA#."rMA, WA 'Y8907, 1W 11) ID 10 1!~ 19 1 ' 1 1 <br /> y U 12. Containers 13. Total 14.'Unit <br /> 11. US DOT Description.(including Proper Shipping Nome,Hazard Class,and ID Number) —�--- <br /> } L No. I Type Quantity Wt/vol <br /> °'i:IaZAROc)Idr WASTE JOLTL <br /> s CLASS '� `dA3077 PG TSI <br /> iG i" .r T etc ill a <br /> E ; sr r� Ns BFN�_FIE x F )� to tJENt i I > <br /> N u. <br /> 00 E <br /> C4 R <br /> •i <br /> A �—L— <br /> T C. <br /> goO <br /> cc R I <br /> W <br /> F d. <br /> Uj <br /> V7 <br /> Z <br /> Q <br /> N <br /> W <br /> J <br /> d <br /> Z 1& rt mW AddU wKd Wornialtwo <br /> WEAR GOI'iGLES, GLOVES, STEEL TOE BOOTS, TYVEK CO'JERALLS <br /> 2 E UNABLE TO DELIVER RETURN TO GENERATOR AT #3 I�BOYE <br /> W EIIERGENCY4"CONTACT g PHONE: DAVE TAYLOR, (20 3) 4666-83- 0C <br /> x <br /> J 16. GCNSRI TUB'S CUTIFiCATICN: I hereby declare that the contents of the consiarmeM ore fully and accurately described above by proper ship.,;ing name ord are classified, <br /> "'t 1 pocked,matted and labeled,acct me in all-respects Inproper condition for Mans urt by I,ighwc according to a 'Coble federal,stave end intarnationol laws. <br /> d P a Y 9 PPl% <br /> U <br /> If I am a `aarge quantify generator, I certify -fiat I have a program in place to reouce the volunto and toxicity of waste genercted to the degren I hove determined to be <br /> economically proctfcnble and that I have selected the practicable method of treatment,storage,or disposal curren+Jy available to me which minimizes the present and future <br /> threat to human health and the environment;OR, if I am a small quantity genercior, I have made a good forth effort to minimize my waste generation and select the best <br /> K waste manogament nw,Mod that is available to me and that I can cfford. —_ <br /> r— �' Month Day Year <br /> 0 Prk4sid/T,yped Name _ Signature <br /> I -= -� " ; <br /> t 1 17 Trane orter I Acknowl. ement of Recei6tt of Materiais <br /> L M P d N° Sig a r /10 rths fear <br /> Yf>e 19_ <br /> OC <br /> .0 a - -- '--- <br /> 0 18. TrompoAer 2 <br /> t Ackoknnl of Reei t of Materch, <br /> LW agm <br /> r —_ Mo I,+ Day year <br /> Prnted/T d Name rgriatureZ /O � <br /> 19. Diu:repancy gat;an ap �,t <br /> d F <br /> U A <br /> z C <br /> I _ <br /> j0. Facility Owner or Ogerafor CortKicatRsn o`receipt of hmardous n a_wfals cc"red by this manifest except s noted in Item <br /> T Printed/Typed Name Signature Month Dry ^Yearw <br /> Y 1. , \\ 'N <br /> DO NOT WRITE B OVf1 TkLINIE.�' <br /> Yellows TSDF SENDS. CHIS COPY TO GENERATOR WITHIN :40 DAYS. <br /> DIS' 8022A i�/o]) (Cellerotors who st bmit hazardous waste for transport out-of-state, <br /> DTS- 022A i Jeroduco com?kted Cory of*!,ss copy and send to DraC within 30 days.) <br />