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arena ratecnon Agency <br /> ved OMB Vo 20-50-40039(Expires 9 3494) See Instructions on back of q e 6 <br /> Pteaw or type Fr for use on eldo(F2prodt)rypewrmrr , p 9 r - ikpartmens aF ToxK Substances Coertro <br />�o <br /> Sacramento California <br /> UNIFORM HAZARDOUS 1 �ip1°rPtPr s US EPA ID No ManmFest Document a 2 Page 1 Information in the shaded areas <br /> WASTE MANIFEST A A. is not requtred by Federal law <br /> of <br /> 3 Generator s Nome and Marling Address `) a <br /> � Number � � <br /> rrro,,t�s <br />� 4y�/ ��j�f J�,L f �/� �,�r��, _'f!%C 1�'�` 4',-//a/ 7�/t' �✓f� f� �%�.�+;� � ^ass M <br /> I "T arg s E.' S r Z rF ry t N <br /> S Transporter I Compan Name ti r <br /> J uv <br /> Q 7 Transporter 2 omparry Name <br /> US PA !D Number <br /> i � r r r�x _ .t,,• v <br /> B <br /> Pa T n Phtkts a -r <br /> 9 Designated Focddy Name and Srte Address "yt�'" <br /> r E7. 1CkSC41,Tt7C 10 US EPA ID Number <br />� <br /> 255 FtLC>r 63 VCS <br /> L Fichnt t►d.CA 94d01 <br /> r 1 3 US DOT Descrmphon{including Proper Shmppmg Name Hazard Class and ID Number) 12 Containers 13 Total 14 Unit <br /> cu <br /> No TZEn Quanrr'y Wt/Vol L W*sle Ntmtbcer <br /> a fk 4! RCRFL HizcUdou. Waist,- Sc lima St : <br /> X12 <br /> EW t-e ET 1[ tV 3 t 0 Y cN e Tar iY, EPA S <br /> 7 r° <br />� ►.J b eA <br /> R <br /> A EPA/Ot?teJ L y <br /> T c sr <br /> O 5f61e ,.yf <br /> R <br /> 4i <br /> EPK/Clfher ==,1 <br /> ✓ 1 I �ti"^ r T <br /> r F �ypw^iy� <br /> EPA`/00ar •: <br /> R <br /> IMed <br /> r , .biAbcatmekx3 � � <br /> S r •� LFL ri.�jjyq.' r. <br /> T <br /> � Y <br /> A+ { <br /> 15 Speomol Handling Instructions and Additional Informahon .r ` <br /> fir''=� �WaF. �Y _dlt �i11rCPS`Of iC I71�;CC1 E Wd4� nl�c�t I1dl� std S '4-,en ✓✓'Luft t. <br /> U C i _ L4 Hr Cc r 1 t 3-t Nit[i>t Fri ii lj�c J <br /> 1E GENERATOR S CERTIFICATION I hereby declare that the contents of this consignment ore fully and accurately described above by proper shipping name and are ciassmhed <br /> packed marked and labeled and are in all respech in proper condition for transport by highway according to applicable international and national government regulations <br /> If I am a large quantity generator I certify that I have a program in place to reduce the volume and toxicity of waster'generated to the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treatment storage or disposal currently available to me which minimizes the present and future <br /> threat to human health and the environment OR d I am a small quantity generator I have made a <br /> waste mono emeM method that is available to me and that I can afford good faith effort to minimize my waste generation and select Mie best <br /> Printed/Typed Name <br /> SrgrwNSe Month Days Year <br /> -:7-4>f r� l � �'{ ! � <br /> 1 17 Trans orFer I Ac wled ement of Receipt of Matermols <br /> A <br /> N Printed T d Na <br /> N <br /> � Srg re <br /> S � Month Day Year � <br /> 6 1 runs iter 2 Acknowled emen of Reser t of Is <br /> TPrinted/Typed Name <br /> Signature Month Day YF <br /> ear <br /> A <br /> 19 Discrepancy Indication Space <br /> F <br /> A <br /> G <br /> l <br /> I 20 Foch Owner or rotor CernlFccmon of receipt of hazardous materials covered b this manifest exec t as noted m Mem 19 <br /> 011 <br /> Y d/Typed Name Smgrwture <br /> Month Day Year <br /> C <br /> DO NOT WRITE BELOW THIS LINE <br /> t Yellow TSDF SENDS TH15 COPY TO GENERATOR WITNNJ 30 CA 5 <br /> BD22A (1/95) (Generators who submit hazardous waste for •anspori oU4 of state <br /> 5700-22 produce completed copy of this cop) and send 0 DISC with n 30 days J { <br />