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i <br /> Stele of Collfornfo—Environmental P•atoctlon AywKy <br /> Forth Apdroved OMB Na.2050•-0039(Expires P-30-991 See Instructions on back of pa®v b. Department of Toxic Subuancoe Cantn i <br /> Please prim for typo. Soeramenro,Califarnla <br /> UNIFORM HAZARDOUS " C1enerafor'e US EPA ID No. Manifest Document No. 12, Popo T Informal on.n rhe,haded areae <br /> is not required by pederal law. <br /> WASTE MANIFEST ofiai <br /> f <br /> 3. Generators Nome <br /> W d Mork g Add e a rf v <br /> �W ^ l :r.�r i...T-,M.�7!J;• y Y »I <br /> e '�.�tY`d.., <br /> A. Geaararor'a Phone frjl 4 ) .{ e�-.5`"F``1^-- a Y =l'! t5't4, Ca0(.aiIJ'I r'• <br /> fv <br /> aV 3. Tran►parrer 1 Company Noma 6. US EPA ID Nvtnbor �'�y"' 'e+l�+lr:'. .rte; +• <br /> ap A11 Va5T-e TMaJV V00 <br /> gn��za haV T41r 3 S'17 ? 6 <br /> 7, Transporter 2 Compm.y Name B: US EPA ID N--bw1 <br /> ^:1 9. Design foal Facil,ey nal 9; dross t 10. US EPA ID Number <br /> Ole) 6 3 9 <br /> 12. Containers S 3. Toea1 - ":LA. Uelr <br /> u •i 4. US DOT Daaerlprfon{Irtc'iuding Proper Shipping Name,Hazard Goes,and ID Number) No 7 ounnil Wt/Vol <br /> E b. <br /> opo N <br /> oD <br /> IS <br /> �e R <br /> CIA <br /> V A <br /> o T C. <br /> m O <br /> d. <br /> ac <br /> Z <br /> W <br /> V . <br /> lu <br /> sq <br /> 2 <br /> V3 <br /> V3 <br /> LU <br /> ac <br /> Z Im <br /> 0 t S. Spec of ftaadltmg Imelruerlons and AddlEriongl lnkrmmfon' <br /> or <br /> W <br /> 16. G ENBU1TOR'S [6RTIFICATION: 16araby d"M that the coal—rs of this Censl Aman?are tally and ateuratoty dastribad above by proper shlpping oomo and are clossI09d,packed, <br /> marked,and labeled,and are In all retpects in proper condition for transport by highway according to opplimbla inremotiona4 am>7 nafiono((gavarnmenr regulat[nee. <br /> If I aro a lerge gvantfy generator.I earNfy rhat I have a p ram in place to reduce the volume and roxtc y of w+as%generated Ie the degree I hove damrmined a be econamiwl <br /> ypmdicable and?hm t hate seleeed the Qtacurable mat6oci of Ireatmenr,Owego,or dlapesal evaanthr arm loble to me wkith minimizes he present end future them to human health <br /> rend the enviranmenl;OR,if I am a:mail quan0y,generator,I have made a good faith effort b minimize my woVa genorohon and select the bail waaM monagement method thor is <br /> available ra me and that I ren afford. <br /> r Prfntad/Typod ma Slgnonrro Menf6 Day Year <br /> z `Z2 , . . <br /> c&r T i7. Tran& rear 1 Enowled anent of Reeei of Material& <br /> (� p <br /> 15 Prin Typed Noone SignoNn Manth boy YeaL <br /> Oti 18- iron r 2 Acknow ed ement of Rxol t of m*,allol& <br /> R Printed/T Name W T TPed Signature month Day Year <br /> I <br /> V <br /> P. DWrapaflcy IndteetleA at <br /> I -20.'Fihillry Owmar or ODerator Carrffieertoei ai vi r of hasardova marerielo eavaramv Ira maaifest ax roi@J in Ilam 19. <br /> T Prf r /Typed <br /> Y Nema Signa? Month I]ay Year <br /> :� L� / <br /> s <br /> DO NOT A114E FLOW HIS N . <br /> DTSC 6022A Id/971 +"`il3; -SCP aENICS ':;ti13 CZ:P" ,i: <br /> ABPA 6700-2:2 .o: ?.'. '-o;: X" <br /> 1n <br /> 7 J ? ! ! 1 1tI cnr r�t.c r. AT IIIjnn• n nrrl rte onu <br />