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Stem of Calltomia--En-tronm•neos vregcnon Agency <br /> Farm Approved OMB No.2050-0039(Explret 9.30-99) See Instructions an back of PCa 6. g 7 nDant OFToxic Su6srances Comr, <br /> Ploosa print nr type. Form designed for use on eFfre(f 2-plich)typawr;rer. Zp 4 . Saaromanb,Callfornio <br /> T. Generator's US EPA ID No.- Manlfeet Docvmen!No. i 2. Page 1 Infarmollcn In the s6eded ereea <br /> UNIFORM HAZARDOUS is not required by Federal IQw. <br /> WASTE MANIFEST 7 fl of <br /> 3. Generorar's Name and Melling Address <br /> �fc�- h!� k _ 1• z <br /> i��a� �]� h •� .' �f �T�f°hp . J �''� Yh kit:rYi Y��: <br /> 10 td, Ganaralals Phone I�!� ) 6•z P V"ACP( <br /> C+ <br /> �7 <br /> cr 5. Tra any ma 6. US EPA ID Number <br /> g D19181203a '9 7i <br /> 0° 7. Transporter 2 Company Name 6. US EPA Q Number <br /> 9, Designated Fotili Name oad Site Address 10. US EPA ID Number <br /> co-e ECOLOGY 614TROL INDUSTRIES <br /> C)Z 258 PARR BLVD <br /> 2 RICHMOND, CA M09 CAi <br /> 0049*61 402- <br /> 1 S. US DOT Deseriplian linciuding Proper Shipping Nome,Mazard Class,and'ID Number) 12' Cv^ta'nen 13, Total 14. Un;l <br /> No. 7 e Quantity Wr/Vol <br /> WASTE EMPTY STORAGE TANK <br /> 3 G Non-'RCRA hazardous waste solid+ j T <br /> E <br /> o N b ' <br /> m f <br /> N R <br /> a A <br /> T G. <br /> rT�p�. 4 <br /> LU <br /> s <br /> a. <br /> w ' <br /> w <br /> Z <br /> 0 <br /> 0. <br /> Vs <br /> W <br /> OC <br /> Z 1'J. Spacial Handling Ieatrurlond Adyllrranal JnigTm n <br /> Wear appropriateeprcftnea"i de cIp flntiog when handlin SITE LOCATION: <br /> Z 24 Hour Emergellmy Talephil Number. -Jev-k <br /> z 24 Hour Emergency Contact:' � ERGS 171 <br /> 16. G$NEFWTOR'S CERTIFICATION: I hereby d•c are that the contents of this conaFgnmenr aro Fully and acCureie(y described above by proper phipping nano and ars clarsi Fied,packed, <br /> IIIJJJ marked,and ibbated,and are In all ratpern In proper condirion for transport by higt,..vy according b applicable inremallonal and national government regularlons. <br /> if 1 am a large quant! generator,l ca�lify that I hove a program In place M+reduce the volume and saxiciry of waste ganerm•d to eke degree I have determined to be eacnomFcafl <br /> aL prectico6le and that 16ava selected the roclicabla method of Neatmeni,storage,or dispafal currently available to me which minlmtres rhe pnaonr and furura Ihrov to human health <br /> d el+ <br /> +n <br /> orae environment,OR,iF 1 am a mall quamtry generator,I have mode o good 61h effort to minimize my wash ganaration and eeled the beer woem.mottagemenr ma}hed that Is <br /> cc O availa6le to me and that I can afford. <br /> Printed/ ed Name Slgnotu J:inih Day Year <br /> Z (/Ll. C' .( . d <br /> C7 R 17. Trane rter F Acknowled emenr of Receipt of moterlala <br /> a e Printed/ Name <br /> e pod Signature Mor16 Day Year <br /> � C i6. mans otter 2 Acknowlad emenr of eceF r of marerials s <br /> 0 g pringd/T ad mama <br /> Qsss E yp Tlgnamre Month Day Year <br /> Us <br /> V R <br /> P. Dlacrepanry Indication SpaceZ F ' <br /> A <br /> C <br /> F <br /> L Ji <br /> F 20. Fact Owner er 4 color Ce '6colian of recei r of hazardous mamrialt cove this manifest exempt ted in item 19, <br /> T Pr'nr yped Name . Signa ! Monr6 / <br /> Y �Iv4�1 % � �y L� r/ ~ <br /> DO NOT r R TEV8E ow • IS 4 E. <br /> DTSC 6022A 11/991 75u% SE'tD5 'i Hlv CCvP.. Ct, <br /> EPA 4700-22 r,,. P.O. Sox 7j--'G. Scc-amunio. <br /> f:_0♦•t:'_C R 7 . Iii.!*n• t, C 1 0M1v <br />