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31ot►Of Ca3dfoorayntal Protection Agency I\ ` <br /> FRrm APP a"20-%-V 39(Expires 9 3496) See Instructions on hack of page 6 n Depart—am of Toxic Substances Control <br /> P60""Print or typer—frnw'+IthrQned for use on ohm(12-prtch)fyFsewrrter Sacramento Califomo <br /> 1 Generators m <br /> US EPA Ip No Manifest Document No 2 Page 1 inforahon m the shaded areas <br /> UNIFORM HAL4kDOt15 <br /> WASTE MANIFEST ? Q �{ t� / `` 1-35 /{ of is nos required by Federal low <br /> C,enqq%1�p�e pp�/� Irng Address r—. <br /> C CA <br /> 4 Gniermo'r s PhJ e,_() <br /> S Transporter 1 Company Name 6 US EPA ID Number <br /> 0 " <br /> 7 Transporter 2 Company Name 8 US EPA 10 Number f <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number <br /> r I <br /> L c d an `l I ( � r'� If t <br /> r t 10 <br /> J <br /> 12 Comamers 13 Total 14 Unit <br /> No Type <br /> s 11 US DOT Description(including Proper Shipping Name Hazard Class and ID Number) Wt/ ��+',C va.-' ` r- <br /> Quantity Vol 'stpreslpefx <br /> .�_.��-t'ri Z�- i. c13' 1 a •�=r., _ 1� rvr��{s„e' <br /> E .7 -' C <br /> N b .►w�°uric . _ <br /> E <br /> f ,< <br /> 4 R Ar <br /> f 5 A <br /> ` <br /> T c <br /> p ., . <br /> R EPA/diet <br /> —Ilw",-W- 6- '-#1% <br /> g - <br /> 15 Special Handling Instructions and Additional Information n ' <br /> Ket:-� _i"4av ftcwn Srv.1_Ces of ignit3.cn Alw ti"_^ Vico-tiFatsL �b-rl "-,—IZ?t7 'Al:-;in <br /> t J G S T I s '4 Hr Cant ar t NW>e p 7 T u T( es r tic�rl -- - --- - ----— <br /> CI�E`�1RC� <br /> 16 434NERATOR S CERTIFICATION 1 hereby declare that the contents of this consignment are fully and accurately descnbed above by proper shipping name and are classified j <br /> packed marked and labeled and are in all respects in proper condition for transport by highway according to applicable inferno oral and national government regulations <br /> 1 <br /> If I am a large gvarNAy generator 1 certify that f have o program in place to reduce the volume and toxicity of wash generated to the degree I hove determined to be <br /> economically prochcabte and that I have nekcted the practicable method of treatment storage or disposal currently available to me-which minimizes the present and future <br /> i threat to human health and the environment OR if I am a small quantity generator I have mode o good faith effort to minimize my waste generation and select the best <br /> waste management method tat is available to me and that k on afford <br /> t Pn /T d NN - �! eF TT yh gnature � ! —_ Moritf Day Year I <br /> T 17 Trarmporter l Acknowledgement of Receipt of/materials <br /> i <br /> I ?noted/Typed Nome Si re Monti Day Year <br /> M 'r <br /> i Sy <br /> 0 18 Trainsporter 2 Acknowled ement of Receipt of Materials <br /> 1 Pnnted/Typed Name Signature Month Day Year <br /> I <br /> 19 Discrepancy fndicatwn Space <br /> F <br /> A I <br /> C <br /> k <br /> 0 Foctirty,Owner of rotor Cerhficahon of recce t of hazardous rn nafs covered by this manifest except as noted in hem 19 <br /> rented/Typed Name Sig re 7(�19101- <br /> DO <br /> nth pay Year <br /> Y �10 <br /> NOT WRITE BELOW THIS LINE <br /> cello., 1SDF SENDS TH-5 COPY ib GENERATOR �.- <br /> TSC W22A (1/95) tC.ei��ro'n whc wLM� hazy -rou waste iJ t 0�,P�- C, � ^ <br />'A 8700--22 00.ice cornni-ted rop of -hi cop, 0-id sere r- D'S'- <br />