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rt <br /> N1 --11aHHi ake:SVahitil'Ad:nay" "�F:tN'%;,Aa-t5!y"r%ry'x i`a�d�4�'sY''°`' 'dj�i?,FPx{,�i `r `rEl � ,.. .. d" a.,�• T'k'�r kpMpiment <br /> of tial, allor"'O'S <br /> to:seras <br /> A r Som m <br /> Mdeliv,rattta§7 <br /> Pb�l'I OMR No.,2060-003a(EaDkee 0• Itch swifter <br /> Mnl'eylvoa florm do, nod for gas mt ap .Manifest Paw t ',`;Trat r YiHlili%�tYl'klf anadeQ <br /> Oanaralar'a UD EPA ID No 'W i "Opcfi I No, -, of '(snot r9quired by Federal I�W <br /> trf�`UNIFORM'HAZARDOUS` i , �, �!� I. <br /> WASTE MANIFEST A. State Manifest Document Number <br /> 3 General a Name end Metlinp Address Jf ! :/(_ �NL '�r x'7 <br /> 71 f't V K <br /> )LY�f'..TI'6?m Nom( F}�1llc.:�JrJ , ( -r,l ..:�. 8 SleIe GMWat a <br /> t :aTs t+ y r Sfoc�ia� Ggs�«tdL <br /> 4. Generators Phone(Z y !— "'/ C State TrenaportGell ID .ef('l If <br /> Yr U9 EPA 10 Number <br /> 6. Transporter 1 C"pem!Name' 6' - r. ,t / 7 '�-_ D. Tr°neporler'a Phorro '�?;7 ,�'. !✓ 1."•� <br /> 9.af: US EPA ID Number E. Stale Transporter s ID 5 XAR=t• __ <br /> TreneportW 2 DomPeny <br /> F Transportir <br /> Neme <br /> 10 Number ' <br /> Pip y, 's Phone <br /> •'Y' O,State Ftcility a ID err �: at x}� <br /> / 10. US EPA T F +j <br /> MiDealgnalad Facility Name and She Address <br /> r?/� ( i'. ..Ll2/✓ H FeahtyaPhoria <br /> s (` tZSS fri�i✓ 'J- 1 'v !I/J T!2 <br /> r k .�.t(.^irbr..� l�, C�/�? "%��t <br /> ;v .. . . _ _ /3. Tolel 1t I_-:. <br /> 'i r +wC <br /> 12. Conlelnere <br /> Ouantity Unit Waste <br /> 11-US DOT Description(Including Proper Shipping Name,He:erd Clue,end ID Number) No Type Wt/Vo i r <br /> nvLt <br /> EPA/gher <br /> o ( U 3 0 <br /> �.V E b'' <br /> R - EPA1Other <br /> A <br /> T State s �` <br /> 5. ,R <br /> '� Stets y(.r <br /> EPA/Other > f <br /> IG Hantllaq Codeelpr <br /> d Above Wat: LbtedAbovr <br /> tonal DasddDtlgnklor ALterlais Lbtet . :� ,+ <br /> Iii i1. Y <br /> ' y 'w�r d �"fj"w4'f.- ��✓ T l-GL r y'9�t 4p %Air'i. `)(�7'� t'�'` jA,)k'. j��'p'� <br /> y�+.e4 <br /> 16 Special Handling Inalruollons and Additional informatlon' <br /> .1g�`i,...gi.} <br /> 18,' <br /> ,. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment ere lolly of accurately described highway <br /> y ova rd proper splicing <br /> name andaredaasNied, packed, marked;and labeled, end are in all respects in proper condition for transport by highway ecwrding to applicable _ <br /> --International and national government regulations. <br /> �t �.i 111 em a tarps at generator.Fcertiry that I have a program In place to reduce the volume and toxlchy of waste generated to the degree I have <br /> . determined to be economically practicable and that I have selected the practicable method of treatment, <br /> storage, or dlsDosal currently available to <br /> + .vime which minimizes the present and future threat to human health and the environment; OR, if I am a small quantify generetor, I have made a good _F <br /> +a''faith effort to minimize my waste generation and select the beat waste management method that Is available to ma and that I can afford. <br /> .,. .;- Month Dry <br /> Printed/Typed Nama ...' ••' ./ < r <br /> 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> Month Dry Year <br /> R Signature <br /> -..A = Printed/TypedNa a <br /> � j <br /> O�", 18. Tnnaporter 2 Acknowledgement of Receipt of Materials ' y. <br /> Signm <br /> ere Month Day ,yYear-, . <br /> PdntediTYped Neme:, - -. <br /> E . <br /> 19. Discrepancy Indication Soece <br /> .:A- <br /> - C..i <br /> 20. Fac,my Owner W Operator Cenification of receipt of hazardous materials covered y�e,llenifeat except as n d'm a tB. <br /> ,'.T Signalura _ Month Day year / <br /> Printed/Typed Name ry' <br /> A }8622 A(1187) TI <br /> Yellow: TSDF.SENDS THIS COPY.TO GENERATOR WITHIN 30 DAYS INS UC ON�0% THEE( CKy <br /> 1E0A MO-22. .. _ Gf <br /> (Rev,B'88) Previous editions are obsolete. <br /> -`1N.CASE OF AN EMERGENCY OR SPILL, CALL THE NATIONAL RESPONSE CENTER 1-800-424-8802; WITHIN ALIFORNIA CALL 1-800-8524550 r <br />