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<br /> Form Aoprowd OMB No.2030-0039 IE.plrn 93P96) S@@ Instructions OA bock of page 6. Deponmenl of 7mk$66naraes Convol
<br /> Plmm prim or Hoe.. Farm dm marl If,we on elite(12p kh)ly ..'W. ,I Sn,'ememo,Calllornla
<br /> t I iG<nerolvi f OS EPA ID No M.0.1,Do<omenl No. 2 Page T formation In the shoded are.,
<br /> " UNIFORM HAZARDOUS - I r-t. h.1 required by Nder f law,
<br /> WASTE`MANIFEST �I+�10J��/ b K/�f��f�l U" (J J �
<br /> 3 Gemrmgr s Name and Moiling Address Stole MarefesE Ogtumwl NJmbil �j�^y}yy < �p I
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<br /> 19. Deugnmed Faddrr Name and See Address 10 US EPA ID Number Oct « F A
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<br /> Q 15. Sts«' I Handling tomnucnaos and Add'dbral Information
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<br /> 1 16. GENERATOR'S CERTIFICATION: I hereby declare Mar the can lfy and ace rarely described obove by proper shipping name and are clossified,
<br /> Q pocked marked,and Iabeted,and are m all respects in pope,condition lar tronspon by h ghway acc.,diN N apphrable mlervfional old n,eaaal governmmr mgulPmans
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<br /> If I a lore.quanrry generator, I c.mfy thm 1 h.,. o p og om in place to reduce the volume and lax icily of rite gome,medl to the do,ee do, I have d..,moed m be
<br /> C 1 eronom cagy practicable and that I have seLd d the p acts ble method of treatment storage,or disposal< r tM oro table m me b,,h mm.rfirc,fee present and f,Nre
<br /> threat to human heohh.and M.anmronmam;.Olt,R 1 am a email steadily genota s, I haw made a gaud faith effort to m n mae my wasfe Inelonan and select Me bell
<br /> c waste mwwgement method that is orailable to me and that 1 can afford. {
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<br /> 19 Dlscr.paoq Indkoaon Space
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<br /> 1 20 iodLiH Owner or Ope s r CemlKoro f ecebt of h d ro - wnd by rh an left except aced'n Item 19,
<br /> T Printed/Typed Name SgroNre .Momh Day Year s
<br /> DO NOT WRITE BELOW.THIS LINE. 1�:
<br /> GENERATOR SENDS THIS COPY TO DTSC WITHrh 30 DAYS
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<br /> ` Drs.. 8042A (1195), a .„ _ To. P.O. Bon ADO, ba<uamom , CA 95812 0400
<br /> EPA 8777y —22
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<br /> 03/17/1998 "ORIGINAL MANIFEST COPY”
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