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Skte of C Ilfoato--Ensimnmereal M1Mxnor Ageory <br /> Form Approved OMB No,2053-0 39(E.pre1 9'A 04) Soo Instructions on back of page 6. D,parrmem at T.'<srml a Cont at 7 <br /> Plea»prim or type, farm dm:grnd lar use on else(12 p kh)lypewr ter _ 5«amemo;Cul8omla <br /> UNIFORM .HAZARDOUS 1. GonerWar',US EPA ID No. hin"Nmt Document No, 1 POge I Inlarmation In tho shaded aregt T1 <br /> is act required by Federal aw <br /> WASTE'.MANIFEST ®SII IQ2, E 1 1 ��.of <br /> I <br /> �I s. Gee t s Name and Mairag Addles, �Sher 6 <br /> >. K` yf°F t!a 'bfn� ;�' � ✓"`i'"T'"�i 1 YA; <br /> "I 1313 .5 �S oaklon Str �9 <br /> h <br /> N4...Generator s Phone <br /> .{ 5. Transporter i Campony Nome b: US EPA ID Numbor <br /> r.L 1 <br /> La ��LJ v Ierr �5.a eA ',�. 0101 <br /> 1 <br /> 7.Transporter 2 C.m.,y Name 8. US EPA ID Number <br /> Q a <br /> V <br /> 9. ib g m d F &',Name and Site Address /10. US CPA ID Number t E[ <br /> �o11501ve4 S ,CeSl Ti,c. �/3� �a/��aa) a A <br /> _ i(oz Bern es as a s <br /> N� s�'Kms e�.' 95733 c to IT 15 4 <br /> t DOT Deee ion" ludi Pro 12. C m 19 .Total 1! Una <br /> i. US <br /> (D Z I rIf (rrc ng per Shipping Name,Haeard Class,and ID Number) �— — <br /> Na T Wamdy Wtrvol . <br /> _ titcif�kc�F !$dna,- ouslf7ms9e, Sd/�� � f 4 � ' 'I r� <br /> 3 <' � , <br /> E o f earl`s DI .M ©71, 136 P aPaA 1� r <br /> w N b.09 E <br /> 5 M <br /> n R , <br /> A <br /> 01 T <br /> Z d. <br /> V ?fie <br /> W4+`"2. <br /> w <br /> N <br /> ZS+f orifi pelmnh'lod Ab vs! y x r�,':' ,.yz tr �r t tF K HpeMwffCodes hY't}�wM l+sMd'A'6o 4' <br /> Q <br /> 15. Spec al Nandi n Instrvdrons and Addmonal Information <br /> W e Fro�R r l°P� cel al ala. Q�7 C iz 5T Ja�� �G27�nD o,# 7573 <br /> � Z V ��gg/o3 <br /> ���,< ��#may; <br /> Jb. GENERATOR'S CE.R.tINCATN. I herebydeclaim that the contents of this cons t are f and accurately descdbed above b pro hi and ore dauilled, <br /> 9nmen fully Y Y Po s pp�ng name <br /> QPalled,marked,and labeled,and are in all respects in proper condition for transport by highway according tg applicable internafiunol and national government regWmions. <br /> V L <br /> If I a a large gaanaty generator, 1 certify than I h w a pragr.m in place to reduce the volume and toxicity of waste generated to the degree I have determined a be <br /> -' <br /> economically,Practicable and shot I have selected the practicable method of treatmrni,starch or disposal currently available to me which minimizes <br /> , imi es the.present and loture <br /> hthreat to human.health card the environment,OR,If 1'am a small quanfisy generator,I have made a good.faBh effort to a mixe imy wastegenerates and select the best <br /> wave m mets method Mat is awiloble to me and MM f can wfcrd.. .- <br /> Printed/Typed Name <br /> e h or h Day Year <br /> VT V. Trans rsi I Acknawled <br /> Z a Dement of R aI f M i .olr� <br /> w <br /> prim Typ Name Sig <br /> Month .Day Year <br /> 0 18. Trans Adrwwled emmt of Rec t o1 Matr_ots <br /> Oe I Printed/Typed Name j�Signature s Marckr Gvy Y" <br /> 19. Diu pa Y Ino cv=ion oP«c ! <br /> H <br /> K e <br /> V A <br /> I y+ �-}-� <br /> 1 E r^�S�'YL_� <br /> I 20 Focil ry Ow r Op r ci,;m at f Us of 1 d "major I ed by tlmica,Ly c""f "led n Item 19 <br /> T Pr r ediTY d Nome S S gnatvml Monts. Day Yea~ <br /> VI'/"-r G'I <br /> I ' I�n��_ ��i;- , . _Lt ' __ 7"�1, �,��__ I�� <br /> DO. NOT WRITE BELOW HIS LINE. <br /> .r <br /> AI 8N2A 19y 97 <br /> -'trim TSCI SENDS T4 C P TO DTSC -T' N 10 DAYS <br /> EPA X 7 ) �' <br /> To P O. 8o ,pt,st ..ec.. scala CA 95812 <br /> . P06-22 <br />