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to N Wmixim (leech and W fte,Apepc. •N � <br /> Opp FMm Approved OMB No.4000.-DOJO(Expeaa%-X}Rgf D W "N <br /> Of C 0 <br /> 6 rtnl M I e, F de let u ke I doh Ta, N�8e1fy1Nela.Ce <br /> d. <br /> UNIFORM HAZARDOUS 1. Wn«.Ior'e UB EPA No. Monlfeel 2. Peps•""?` <br /> WASTE MANIFEST (p Z ° of 4 <br /> A, Generntar'e Nem.and Mail Addre.s A 1e e1NN1 <br /> VALLEY INDUSTRIES, DIVISION FISHER GROUP <br /> 1313 S. Stockton St. , Lodi, CA 95240 IS. &i1• • N' <br /> 4, Geneflior'a Phone(209 368-8881 Q 4 z p'• <br /> 6. nepsnl I Comp.ey Nama6 UB EPA ID Number O. M41♦Tr e <br /> IL 1 RV 11A(*)%L, C � O. irAMpMePe <br /> 7. Trnnspon.,2 Company Name 6, US EPA ID Number E. Male r.naprlHele <br /> P. Treneporlar's PNdhe <br /> D. Designated!Facility Name and Sit.Address 10. US EPA ID Number 0,•$1.10 F. ilii 'so <br /> IL.QC OEyEv�/J Out <br /> >•' 11'T r1 AL)t(v{.� N. F.cllif's Phi <br /> CIAL. IIC jill $ t I I I f<1 LII - xt#wv <br /> 12. Comene. 13. Tole M. I. <br /> 11. US DOT Description(Including Proper Shipping Name,Hazard Ones,and ID Number) Quantity Unit Wool*No. <br /> j y1__,,��� No. T,Pe IND <br /> G a. �►,IIg9TE �I ote-u TI 01La VUV �'1FJ•A0T�8 �1 41� 91617?J� <br /> e X NR ino 1 n EPA/oma, <br /> E o. G <br /> R Mal. <br /> A <br /> T EPA/Ottw <br /> O <br /> R 81Ne . <br /> EPA/Omw <br /> it Me. <br /> EPA/Oban <br /> J. Additional Oascriptiona for Material.List"Above - K. Handling C:deal'ar Wass"Lblea Above <br /> A b. <br /> L Z WDL'E'E 12 d. <br /> his <br /> II16. Special Handbng lnatracnOna and Adam.. al fn)ormaaon -- i <br /> 1 <br /> 1s. <br /> .GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are lolly and accurately described above by proper shipping <br /> name and are classified, packed, marked, and labeled, and are in all respects In proper condition for transport by highway according to applicable <br /> international and national government regulations. <br /> If I am a large quantity generator,I certify that I have a program in piece to reduce the v;Iumo and toxicity of waste generated to the degree I have <br /> determined to beeconomically practicable and that I have selected the practicable method Of treatment, storage, or disposal currently available to <br /> me which minimizer: the present and futurethreat to human health and the environment;OR, if I am A small q,.Only generator. I have made a good <br /> faith effort to minimize my waste generation and select the best waste management method that is sa_13tle to me and that I can afford. <br /> Printed,Typed Name Signet ure /J Month Day Year <br /> Fred Baumbach C49Z�i 3 CJ 7fS <br /> T 17, Traeeponer 1 Acknowledgement of Receipt of Materiats <br /> R <br /> NPnnled/Typed Nama. Signature Mone Day Year <br /> S <br /> 11'1LeC SC1hcAc - //. -Z-- J Id' <br /> P idt Transporter 2 Acknowledgement of R caipt of Materials <br /> R Printed/Typed Name Signatwe Manth Day Year ,x <br /> E 8'Y$!lX$�14101DHS1T1 <br /> e. <br /> 19..Discrepancy ladicitnon Space g <br /> F <br /> A q <br /> e ; C , <br /> 1 <br /> L <br /> I 2n. Fatuity Owner or Operator Cedifiearion of receipt o1 hazardous mate,ee covered or thisanifaat xeapl as noted in sem !9. <br /> < T'. n <br /> Prilad,T <br /> .v ypetl NemeSignature Month Day Year < <br /> r� 1Aa'r, z 1 10, <br /> 7 12-31,917151 <br /> *EPA a801 2 A e7) Whitc;,TSDF SENDS THIS COPY T DOHS WIT IN 30 DAYS / INSTRUCTIONS ON THE BA <br /> (Ree.R-86) Previous edamne are obsolete. To: P,O. BOK 3000, $a omento, CA 95812 . t� <br /> s <br /> CASE OF AN EMERGENCY OR SPILL, CALL THE NATIONAL RESPONSE CENTER 1800424 8802, WITHIN CALIFORNIA CALL 1800-862,7660 <br /> 03/25/1998 "ORIGINAL MANIFEST COPY" <br />