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UNIFORM HAZARDOUS I " 'us Mo.met OOCte ent NO 2. Page I ! In <br /> larmafiao in the Shaded oreas <br /> I WASTE' MANIFEST ` a( i5 pl req'llraa Ly Fadmal IP <br /> C S 1 [ 5� l s <br /> 3, Goaavolo's Name,and molinq Add•ess A. Stora Manifeaf Cooment Number <br /> .,; - .. 23570959 <br /> � B State G.MmtOr'3ID <br /> A. Generomt's phone ( •'i) �. 0!;. .',Ct,. 'C;::`t *; s" i. <br /> N <br /> � 5.Tronsporkr 1 Conpaay Nome 6. U5 BRAID Number C. State Traesporieh 1D fqaa.,ed,l <br /> 00 <br /> r ^ S7 7. 7-ans ar'era Phone 114A <br /> . 7, P <br /> 7, Tronsponae 2 Company Name 8. EIS EPA ID Nombar E. tab Transporter's ID Reserved. <br /> 5 po (_I <br /> �Q F. Iranspor'.er's Phone <br /> 7U 9. Oesignoled,F,: it/Name and Site Address 10. US EPA ID Number G. Sim.Facility's ID <br /> M'MM. CIS <br /> H. Focility'e PhmmI - - <br /> )Oj CA 94:801 � ..`i�% �' �� - - a] 'i^:il ' 3,'9 J-s- --3 - . <br /> 12. Containers 13. Tolol 14. Unit <br /> 'U 11. US DOT Description lindudiag Proper Shipping Nam.,Hozmd Clam ane ID Number) No. Toe puanfity NT/Vol I. Wos1e Number <br /> ZZ <br /> / �y [6PA/Olh-r' <br /> 3! rn :a:'�d:C Gla:> / pt`a A!iG ae lf:ii OQ ! • / 10O <br /> E 6. Sial, <br /> o N <br /> oa E <br /> VR EPA/C4. <br /> v A <br /> T c. S¢e <br /> o <br /> m O <br /> EPA/01H., - <br /> a <br /> aW- d. Stale - <br /> Z <br /> W <br /> V EPA/011ier. <br /> w <br /> N 1..Addtaard Daxript'pns for Matenali,4ist�,�opYG.. == � p�' C�� �,. IC Handling Codas for'Ncabs Listed.46ove <br /> Z <br /> 0 - . . a. b. <br /> N <br /> a <br /> C 1s5�Special andting In nrrlian and Additional Informodan ea . <br /> Mar prboez ver'.,.}'3.r ive <br /> Z �=� 3"kC;.iiK 2i'Xe,ca".r'3,>,a'� vv'C.L?_GE'w/C•G= QP'Sp4yGi!/�/r= ._ �. ••• � ••. •-•�• <br /> GitEl•-a <br /> Id. GENERATOR'S CSRTIFiCATON: Iherebydedam that the canlenh of ihis<onaignmanl aro lolly and a<wrably described obore yy proper slopping name oral me couilied,packed, <br /> Jmarked,and labeled,and mein all respects in preps,condition For tronspmi ESy.nighway aawrding to applicable inlerrwliano(ond notional government regukiions. <br /> J IF I am o large quanlify genembr,1 c.rtiiy In.$I have a pmgrom <br /> m in place to reduce the voit s and htxico of waste genwtted to +..degree I have determined to be economkolly <br /> o_ pmclicobb and that I ve saiecled the racicable method of imalmenp sloroga,m disposal currently awilable to me whkh minimizes the prese.1 and;aum.fhreal to human health <br /> ti <br /> s and the a to a and t at I if I am a small geanlily:encore,, have made a goad faith e57ort to minimize ary wase genration and select the beat wash management method That is <br /> 0 avaifoble b me and that 1 con afford. <br /> } ?rinted/Typad Name Sign i 10P740AWSign Monlh Day Year <br /> w c r' ,r' 14 1710 IV <br /> kDT i7. Trane oder I Ackiowiedgemant of Receipt at Malanab <br /> w g A Printed/Typed No me SignolureNanlh Day Year <br /> P <br /> w s i 1 6 i7. a ' <br /> Si fl 10. Trona orlr 2 Acknawled emaM ai Rami i of Malerids <br /> O 1 Prinied/Typead Name Signolma Month Day Yea' <br /> y E <br /> Q P <br /> V 19. Dimrepcncy lndicclion Space <br /> Z F <br /> — A <br /> C <br /> I <br /> L <br /> I 2D. Facility Owrer or Cow.tw Cadificwion of ..jipt of hazardous mot.6.6 covered by this muni Fest ecaipt a noted in Item 19. <br /> Y Prinw/Typed Name Signalure / I ' year <br /> I <br /> _ 1 <br /> yD�OC DO NO RITE BELOW THIS LINE. <br /> DTS.: 3022A 11/991 Whi:e. T5DF SENDS THIS COPY TO DISC Wliri!N 30 DA"!S. <br /> EPA 8750-22 To P.C. Bax 3000, Ssrmento, CA 95912 <br /> LL'd bbbLOL60L9L PUOW401a - 1 0 3 R":LL g0 til Dao <br />