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7 <br /> $late of Calllomla–Health and welfare Agency See Instructions on Back of Page 6 Department of Haanh S"f 06 <br /> Furor Approved OMB No.2060-0039(Expires 2.30-9 t) Toxic Substances Control Dlvl•INl <br /> Pleese print or type. (Form designed IN use on ethe(12 itch and Front Of Page 9 $aanmplo,California <br /> _ p IypleylfN)� <br /> UNIFORM HAZARDOUS L Generators US EPA ID No. Manifest 2. Pagel information M the eh.Wd Nees <br /> WASTE MANIFEST A D CJ S 6O 7 Document No / <br /> 10 io 10 W in nottionrequired by Federal room <br /> 3. UOhl ar'e Name and Mailing Adrkesa A:state Mosia"I DooWy ' <br /> VALLEY INIJ• D/d/S/O.v ' 003 <br /> 1313 S. STOCKTO)V 174e&,err, Lap/ Ca4L1F0eN14 D. alaa.nerawre ^ <br /> C Oonealor'a Phone Q1q) A�Jq <br /> _ Q 6. TrenapMer I Company Name / /119 EPA ID Number C: Maar TnnapxlMe K3 <br /> CHE TLS //rig A K 711 we <br /> L.Transporter 2 Company Nantaa. US EPA ID Number IL slat•TronportN'e to <br /> 9. Designated Facility Name and Site Address 10. US EPA W Number 0. $late Pac fNy'a to <br /> YEIAX 4L WASTE MANA6EMEA? I/VL- C / <br /> ETT ,Ellfioi/ H/LGS' F C/.G i_ay P a, , <br /> Ot.D KYA/NE.d�/KE7" Lo'Il>AN C/TY = <br /> 0101 01641611111 8Gt'1- <br /> 12. CNltai.... 13. Total to f. <br /> 11. US DOT Description(Including Proper Shipping Name,Hazed Claes.1010 Number) OWnthy U04 0 No. <br /> No. Typo 10011101 <br /> U a. ` <br /> D l'AG 1Fi�iZN/A REGULATF_!J VIAS T,E ONLY O O x 7 7 Ar <br /> E <br /> N <br /> A It. <br /> 14AZAIZDDLIS 1/YAST,E -04117 Al. 0. S. ��—��� -- <br /> T U,eAA-E AIA -- 9199 0007 a 5 P A0011 z <br /> D <br /> " - A/OOW <br /> ¢ d. State <br /> U <br /> 8PA[C%.1N <br /> ?? J. Additional Descrfplloas for Matenal,Listed Above K. FlaridWip Cooca for Wates Ud&dd Above <br /> y ���—•--^V ^��'� <br /> t <br /> i5and Additional Infmire thi <br /> PO <br /> ,y t 95G( <br /> $ENEIUTDII'e CEIITiICAT10N: I hereby declare IMI the contents of this consignment are fully end aecurulaly described abow by proper ehippiid home <br /> And we classified.packed.marked,and laNled,and are in all respect.in proper condition for transport by highway according to applicable international and <br /> natural 9ovNimiont regulations. <br /> N I am a large WamtlY generator,i eMify that I have a program in place to reduce the volume end toxicity of waele generated to the degros 1 Have doieonmM ' <br /> to be scono n.ov pr•ctic.blo and that I have aslactM this Practicable method of frealment,stores,or disposal 6errenily nvaAsbla to me which minimizes IM <br /> praaoM sail Mere Invest to human health and the enNronmerd:OR,it i•m a small quantity generator,I have made a good faith effort to minimize my waste <br /> genmtlon end sNecl 1M best waste mamgempl Method that is available to me and that I can afford. _ <br /> PrwIA/ ypod Name 6lpnetu Gbnfh D•Y Year <br /> 0`-,26V 13A1!fi CN6`5Atl1917 <br /> 17. Transporter 1 Acknowledgement of Receipt 01 M.tonsts <br /> R <br /> A PrMedrTyped Name Signal Month Day Ysn <br /> "s �- ti G <br /> JIB. TranpodN 2 Acknowledgement of Rewlpl of aledata <br /> R Primed/Typed Noma Signal... Month Day Year <br /> T <br /> E <br /> 19. Discrepancy lndioetbn Spec. <br /> F <br /> A <br /> (..0 <br /> L <br /> i 20. Fadlhy Owner or Operalor GriNlo•tion of racalpt of hazardous materials covered.by this manifest except as noted in Nem 19, <br /> T Prntad/Typed Name Signature Monts y Y� <br /> kA el 1/1 <br /> to <br /> 6o22 Aft rax). Do Not Write BO&This Line <br /> 'eTao--22 Whit . DF SENDS THIS COPY i0 DOHS WITHIN 30 DAYS <br /> Pnvbw eddbna are obsolete. <br /> To: P.O, Box 3000, Sacramento, CA 95812 <br /> ';; 3/25/1998 "ORIGINAL MAN IFES'S COP4" <br />