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i' <br /> Slate of California—yballh and Welfare Agency See Instructions on Back of Page B Depsnmant of Health Services <br /> Form Approved OMB No.2060-0039(Expires 9,3091) and Front of Page 7 Toxic Substance,Control Division <br /> Sacramento,California <br /> , please print or type. (Form designed for use on elite(12 Pilch typewdfer). _ <br /> UNIFORM HAZARDOUS Genetemr a US EPA 10 No. Manifest 2 Page 1 Information M the ahaded areae <br /> WASTE MANIFEST O yt N 0 Z 0 oeamgm 11 o. of / la not required by Federal law. <br /> 3.FGS�-oto "4mv�DVi'dr//�/C•. 1//ILLtY /ND. v/1/ AON A, 81.1.Man umenlNu brt <br /> /313 S. ST60C TON STRZ ETf LOD/,CAZIFD/'N/A e. slate wn«8alolto <br /> 4. Generator'.Ph...(cc?)3,:�A-SSB/ 95240 —H-11"IfIVI231ii 1111191471 <br /> n 5. Transporter I Company Nam; <br /> MAP1/u;tr7Ac_ If EPA to umber C. SIM.Transporters D >< <br /> A T / D. TranaportKs PIIOM — — — <br /> N <br /> 'm T. Transporter 2 Company Name 8. US EPA ID Number E. State Transporters to <br /> m <br /> Q F. innaportN'e Placates <br /> 3S 9. Designated Facility Name and Site Address Io, US EPA 10 Number G. State FecWty's D <br /> CHEAWCAL WASTE MANAGcM6V;r /NC- CiA i TIA 010(y /i T <br /> < <br /> MQ sEerTiLEMAN N/LLSFAC .l/T /Fciy's P -r <br /> Lea ow sYL <br /> -296 y <br /> _ <br /> I-A# Irzoz AV 94 z22 <br /> 12. Containers 13. Total IC I. <br /> Q Ow I1. US DOT Description(Including Proper Shipping Name,Naxerd Cie..,M10 IsNumber) Quantity Una I Woo.No. <br /> D <br /> CNo. Typa WI111.1 <br /> N Q — slab <br /> D <br /> MZ G �p>71 w T yY �v EPAIOIher <br /> W� E O 5 VAS /� SOL/O O I r <br /> W 3 E b. Stele <br /> " A /\/ON I?CleA AIAZA/01361JS WA.i7,E SOL10 EPA1OIher <br /> T OC 7Z1 P <br /> N R c Slate <br /> 'ir8 EPA101her <br /> ¢ d Stats <br /> w <br /> z <br /> z <br /> w EPA/Other <br /> u <br /> N J, Additional Description.lir Materials Listed Above K. Itendlinp s lar Wa.....I.Above <br /> O a. b. 1 <br /> Q. <br /> to <br /> w o, d. <br /> J <br /> Z <br /> 15. Special Handling Instructions and Additional Information <br /> w �= Pi70r/LG_ SFD NN3[5'Gy—O/S �O3z / <br /> J <br /> U In <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> end era classified packed,merasp,and Iebalad and ere in all respects in proper condition for transport by high::ay according 1.epplice.1e internetioeal and <br /> IL national government negubh.ne. <br /> m If I am a large quantity generator,I certify that I have a program in place to reduce th.volume and toxicity of waste generated to the de91.c I have determined <br /> 0 to be ecanomieeily practicable and that I have selected IM practicable method of treatment slorepe,or disposal c.rrenily available 1.1 me stir ch minimizes IM <br /> present and future threat to Kaman health and Ina environment;OR,it I em s smell quantity generator.I have mgird faith <br /> a gfaith art Io minim a my walb <br /> n <br /> Q generation and tici the beat seat.management m_hco:hat is wadable to she and that I can afford I <br /> Z -- —' Morfn. D. Yea- <br /> w Printedl Typed Name Siuna.. n <br /> w FM50 RA41MEACH �' > <br /> wT. 17.Trenep.rier. I A.canowledg.,h.m of Receipt of Materials <br /> Z R — Signator W-61 Dey Year <br /> < A Printed l Typed Namely �— <br /> ON �d.c.V�'s' <br /> S <br /> P tee Srensponer 2 Acknowledo...hu of Receipt o1 Materials <br /> w O Month Day Year <br /> Q R Printed,Typed Name Signature <br /> U E <br /> 2 <br /> 19. Discrepancy indication Speer <br /> P <br /> A <br /> C <br /> I <br /> 1 20. Facility Owner or Operator Certihcetion of receipt of hazardous materials covered by this manifest except as noted in he 19. <br /> Y Printedi TypeS d N n / Signature - / ' Hong Dai Year <br /> {Q/f / ` A, n <br /> DHS 8022 A(vas) ` Do Not Write Below This Line <br /> EPA 87DD-22 Whee: TSDF SENDS THIS COPY TO DOHS WITHIN 90 DAYS <br /> (Rev.9-88)Previous editions are obsolete. <br /> P.O. Box 3000, Sacramento, CA. 95812 <br /> 03/25/1998 "ORIGINAL MANIFEST COPY" <br />