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Stare of Cal;Farnfo--Fgvlranmenfol Promeflon Agency <br /> Perm Ap•raved OMB Na.2050-9C3+IFarpiros 9-30-V9� Sea IfIStTUGF10DS Of! back of PC a br Department of Toxic Subaranea+Conitr <br /> Plaosa pians or typo:' Form.danigned for use an effre f U-pircb)rypevrriter. Sacramento,Collfornlo <br /> 1. Generator's US EPA ID No. Manilast Doewmens No. 2. Page 1 Inlormedon In 6e ahaded erect r <br /> UNIFORM HAZARDOUS is no required by Poderal low. <br /> WASTE MANIFEST 1Z of <br /> 3. Goneralw'i Named JtUingAdd <br /> (r[/ :1, yt j <br /> a� f �e �yY'� ti {f4 rr uni <br /> b lt/!��Y�j .e.A,c <br /> �n d. Generela/s Phone(!K-1 16"V'O <br /> r\ <br /> C4 S. Transporter 1 Company Noma 6. US EPA ED Number <br /> C3 iYUm wwrdrr`U'slreseral wV1l IinfYrlMrsiru 10qa y v. � <br /> jr 3 <br /> a� 7• Transporter 2 Company Noma 8. US EPA ID Number <br /> rJ � <br /> I r c li 10. US EPA ID NJ-b., <br /> z <br /> . 2a6 PARR isLVO <br /> O <br /> 1� RICHMOND CA S4801 40031912 <br /> Z12. Conlainere 13, Total U. UrIP <br /> V 11. US DOT Deterlprion(Inelvding proper Shipp;ng Name,Hazard Claw and ID.Numisar) No. Quo-ii WI/Vol <br /> WASTE EMPTY STORAGE <br /> 3 `G <br /> NOK.,RCRAHAZARDOUS WASTE SOLO, <br /> b.. ?. <br /> E <br /> e A <br /> T <br /> O. <br /> it. <br /> z <br /> Ln <br /> LUV <br /> W <br /> L <br /> fn <br /> 0 1 S. Special Handling Insrwalw3 and Additional Infvmgeon <br /> a Wear proper protective equipmentwhile handling. Weights or volumes are.appirpAmate. <br /> 24,Hour emergency telephone number. <br /> 24 Hoerr emwqency contact: P,c X ,1-v DOT <br /> EfkG#171 <br /> 16, 0MRATOR'S CERTIFICATION; i hereby declare rhor she Conlon I&OF Ihla eantl nmanf are Fully and accurolely described above by proper ahlpping name and aro elosslffed.pocked, <br /> morked,end labeled,and are fn all retpeers in proper eendirien far Iranrperr by h10hv.ay according to applk.ble Womarlonal and natlpnol government r•quladanf. <br /> If I am a large gvenrtry aenorator, i eerr;Fy that I have a program In place to reduce Phe velvma and aenlelsy of wasm generated to the degree E hove de3erminad to he econamfeoly(y - <br /> pracrieabl.and that I kava.elected the peorricobl■mNhod of treo(manr„trorage,or dltposal wrra mly available to me which minim;:as the present and future lhraat to humon h.ahF <br /> and Iho environmens;OR,if Iam a small gvcntly generator,I have made o good Fa;lh aFkrt to nimlze my waste generation end solea rhe bast waste monagem•nt method that 11 <br /> O <br /> available to me and that I can afford, <br /> Prin Typed Name Signature Monih- Day tar <br /> a <br /> (9 T 17—til, o r! kno ed em t of Recd I o oter;alt 17'v-oOr <br /> R <br /> t1 <br /> Prima r _ MemhDoy Year <br /> 0 IS- T s rler 2 Aeknowl .meet of Race&Ihialarlel, <br /> 1 Pr;n /Typed Name SFgnalaDay Year <br /> ts.r F <br /> K p <br /> („) 19. Dlscrepaney Indlearion Spoe. ' <br /> ff . <br /> ? A <br /> C <br /> l <br /> F 20. Fecili Ownor Rr O orator Cenl(Ication of rocoi I of haaardaut materials terver•d by this manffest except as note ;n Item 19, <br /> T Prinred/T ed Nam• Slgnarvre <br /> Y y` r^ nth F]ay� Year <br /> (J�t1J UU ij/> <br /> DO NOT WRITE BELOW THIS SINE. <br /> OTSG£022A{]/991 h:ra: -=, _ t: "?IS .-. . 7C <br /> EPA 9700-22 scr, 0, :cc:_:,err, ... <br /> C • .J ; 1 F I • AFI r. nnr• nLn nr,7 ie� i;n. n ern � . n nn;; <br />