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Stab of Collfomkz--Enviremmsrzal Pr IeaNen Agency <br /> Farm Approved OMB No.1050-00391Enpires 93D96) See Instructions on back of page b. oepanmen of fork Seboom.,Control <br /> Plemu print or.type --'Form despead for tie on ene,(ITp,kh)yPewnre• Sa<ramenlo,CaGlorno <br /> i I. Gemralo/s UD EPA ID No. . Mon fmt Da Amrnsl.No. 1 Page I;� Infonnaton i Ph.shaded.,..I <br /> 17777 UNIFORM HAZARDOUS 'I �j /_ is not req.1n d by Federal Inw I <br /> WASTE MANIFEST Q S4 (0 O Z I 2 ( Yl of <br /> 1 1 _L1.1.1._ L 1 —IZ f tiv.F <br /> 3 Generator's Name and Ma;bng Address / A $IgblNwn)fHi DOCYM $ <br /> -h 15�I Yf GYo4d {"xl rrrsT7m� � fr <br /> C" /?13 S. /S �"fo�i S1 • e sroro aea.earl fD;a r' t t • h" " a <br /> : A..CmrNreNr+Phare y�0 3�8 bE81 Cod; .7 <br /> S. Tronspodu I Company Nome d. US EPA ID Nomber09 <br /> ry f8 Y <br /> a�IaJErt✓ifDPi. $L'CS.o�CY4Tru.ICI�iL�I010141011�13 N111M <br /> 7.-Transporter R Company Nome — 8. US EPA ID NomberStgMyt*i, e fY <br /> - FSr ' y " <br /> 00 Z 9. D.,ignmed FO�C!ity Nome and Site Address 10. EPA ID Number G� taka PoniRy s ID =y 1< Fy "Al <br /> xyf h e a�F y - <br /> .SdIUP-0.'� S ¢TV ILPS1n C� .DV3f; Layct'I�s1,J rimer <br /> N� (021 Q -ryBSSa oa Thufify' Prone a ,e„x aa' <br /> ct< Sak ase C ' 95/33 A'DO S9 k `l i t 0 ..,_ 0 - <br /> u ev <br /> '�nn I1t.US DOT D.sed tion id Pro Sh Name,H and Clops;and ID Nomber 1Z Comamen 13. Toil LI. Ung y 3T #e <br /> W P (�^c uq Por PP^9 ).. No T Civan6y Wt/Vol <br /> 3 NON P-CP-A 0.Zar-douS asy'/ <br /> 'r <br /> E <br /> Coil l a a 90 { <br /> IN <br /> H <br /> E <br /> o +, <br /> R ✓` Q ' 9 i <br /> V <br /> Z <br /> r• .. � p , Ly. d .�q � <br /> 5 <br /> t b� <br /> O15. Special HaMlmg In+bvchom and Additional In men.mm - A /f/J 03 <br /> Z <br /> E�!>"�) �f A W ftW +a�r Pi°E fAl( ¢R� tiµc�jiny. <br /> I Of ge Ervi Qes,c,t �l o.,E (�9� 3G8-P8 / «sT obi C2yo3 <br /> IE, GENERATOR'S CERTIFLCATIOtf. I hereby declare thm the contents of this consignment are folly and accurately described above by proper shipping name and are classified, <br /> Q 'pocked,marked,and labeled,and are in all respects in proper condition for transport by highway aaording to applicable inbrrwhonal and national government rcgulafian+. <br /> V <br /> II I am a large quamry gene,aim. I romfy that I hove. program In plot.to rdoce the volume and rovcity of waste generated to the degree I have derermined to be <br /> Em economi oily pract<able and Mat I have selected the practicable method of treatment,smrage or disposal c,j,Nnty arolable to me wlr n enmimr.rhe present and Imre <br /> N dine./N,homer h.oilh and the..w.nnenb OR, A 1 am o small Iquanfity generator, I have made a good faith effort to minimize my waste generation and sele .the bea. <br /> m wo+N management method that it available to me and that I ion afford. <br /> 0 PHnhid-/ ed Na e /1 / 5geozr. Momh Day -yearn <br /> Z 1 11 Trans wear 1 Acknowled of Rece t of MmerKa -_ _ <br /> mens <br /> 0 a Prim /Typal m. 9 Sig Monts D <br /> W /1 � on ClPa fn _ D C)i� �6 <br /> pj 0 1B. irons ort..g A<k,wwlad .mem of Racer t of Marerols - <br /> 1 Pneud/Typed NA. signature Morph Day Year <br /> C) 1 <br /> W 19- Dlu ooncy Indmos;an Space - <br /> N <br /> F <br /> U A <br /> Z C <br /> s - 1 <br /> l - _— - RLS It�- y <br /> I 20. F.1i Owne o� a e r.,aPo r ,+ate h- a as a l—d b� i.r_s t e nem 19 <br /> Priotad/JYWdhi ms : . S'no" MonthDaY Ye°. <br /> y �IIQ�� I� �� MGI <br /> DO NOT WRITE BELOW THIS LINE <br /> M., TSD}...ENDS -H,S COPY TO DISC WIfH 30 D4-1- <br /> CA, <br /> A".,A 'rsla <br /> 03/17/1998 "ORIGINAL MANIFEST <br />