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UNIFORM HAZARDOUS °orWor's US EPA ID No. teles hest Dacumorl l ,. Page I Informalian in the sl'.wood,araa:a <br /> i <br /> I, wasrE MANIFEST 101AIP "119"It I w b161'{lyl � `�I ( I l 3 "7 of <br /> s rsor rcguimd by Federal(aw. <br /> 3. Gmmrulor's Nome and Mailin Address A Stole Manilast Documanl NwAns, Y O w J � ^ <br /> SHIR I., iii€, r'�2f�t'sRt1';.�(S,1 1;h1 4 SVd {4 J� <br /> $S'-r• kiit� T, i'C«u';- 5::3 <br /> B. Slate Gvnera�lo.!r's 1D <br /> \ <br /> A. Gonnrolois Phone 1 :31) 3,`4•122U MIFT Z40E JilItART41 EZ s. �'� •�' s! 7 71 <br /> 9. Transposer l C mpI Name d. US M ID Number C. Stole Transpoher 31D IRcsen•ed,� 7_ l <br /> di <br /> C.':t0iYS9 <br /> o wwh. 61S D. Transpols Phone � � _� 0.3 <br /> - <br /> �-�_ 7. Lvnsportar 2 Company Name B. US EPA ID Number E. Slatd Transporter',ID IResarvvd.; <br /> F. Cransporter's Phu° <br /> �9�. D�eys�.g�nnmd Facility Name and Site Addruss 10. US EPA ID Number G:Stole Fecilhy'e'ID10 <br /> .. <br /> n+.a„si!t'1e reNnu�w ww.s.9••osisw <br /> D I =5 PA.R6t R'LVIr< D H. FacililysPhone <br /> n i:iG7a9d�a",tyif ti A k�'�i5 � ` -: t11 '"` . -5 r 7 <br /> 4 s31' 33-t343 <br /> 11. JS DOT Description findaper udrng P Shipping Nome Hazer d Class,and ID Number) 12 Conteine:s 13. Tolyl lb. Unit <br /> ' "h No Type Quonlily Wt/vol 1. West.Number <br /> .. <br /> Shalt <br /> . n PIP( G) EPA,rousm6161 rM d <br /> T <br /> :J 6 <br /> State <br /> s C <br /> H EPA/Other —�— <br /> Ac. Stair <br /> 12 I EPI <br /> u I j � d' Store - <br /> ju <br /> ju 4 <br /> U � EPA/Olhdr <br /> w <br /> t` J Additional 6asgipfi.3 ler Motnrlals Lisfdd Above , 7 -- 7 K. Handling Codes For Wastes listed Above <br /> 6. <br /> a t .k f 8.U]:{-7I7'r''(l'7 CS;ME.tI}+yt�idE'6etYtw4.#//"P-sS^! �-t.7- -F—s--/ . <br /> =� ' 3ai�a}:ail ti3 <br /> J -- <br /> n15 Special Handling Instructions and Addilional Information <br /> i,' �riPri;.r7i!''Sb�!!+.f�sadt€Nc>!i:'ay+rtsvlu;>� iae'b€ 2![F'; 6�:�kti:�€i�1re `sfiisi( 1kf rr+r!It��a,Ftyl.� <br /> <. "J�dpa......,.......y', W.:.�.e�..�. e . ::+..`..: :'fvt 3 •6. .ETS*.d' .^'d !"Y: <br /> it. �lY':'fo�.'Y�i'� .:a.. I,43ZI i•�-. PA-I S+'e µ{4r+@CA <br /> - 16. GENERATORrS CERTIFICATION: Ihereb &close Rvat the contents aF this consignment are rot nndoccutant descr;6eda6o i,ypraporshi,ringnam°ondamclau:fied,pucked, <br /> nmrked,and labeled,and are in aA respects in propw condition for tramper)by highway a ording loopplitocle inlernolionol and national government regulations. <br /> II 1 am o forge quantify generale"I cerfily that I have a proggram in place to reduce the volume and toxicity of waste generated la the degree 161 determined b be economicallyy <br /> Pro <br /> aicab1.and that 1 ave mlecmd the ppracticaale method aF trea•ment,storage,or disposal rurrendy available Ia me which minlmizm It.pmsent and t0.ra threat to Mmes ha= <br /> and IM enwonnsonh OR,if I am o small quantity generator,I hove made a good Foilb effort to minimize my waste generation and select the best waste management method that is <br /> oxaih6la to me and that I can afford. <br /> Printer)/Typed Nume Eignab Month r Day Year t o <br /> 1, 17. Trans anon 7 Atknowled omen)of Rece10(Mctmials <br /> v Name Prinmd/T ped N <br /> Y Signature A4anfh Day Yyyoar <br /> w v <br /> 1B. Irons oner2 Acknowlvd ementoi Rocei tel Marshals <br /> =u T Printed/Typed Name Signature Momh Doy Year <br /> r E I i <br /> Q R <br /> F 19. Discrepancy lndicoliar Space <br /> - a <br /> I I <br /> 1 20. Focili Owner or Dawdler Certification o1 receipt of hazardous materials covered b this manifest exce t as rated in Ilem 19. <br /> i T <br /> Y Printed/Typed Name Signature Monfh Day Year <br /> .. 7 e 't I. <br /> 4010(o —App— DO NOT RITE BELOW THIS LINE. <br /> it y e>Cy — <br /> '2A(),'991 White. TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> —22 To: P.O. Sax 3000, Sacramento, CA 954)2 <br /> Z'd bbbLOL606g6 PU0Ua4Dla I 0 3 e04:11 g0 t7 D80 <br />