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rs <br /> ra of Caidgmro---En,+ronmerroi prof=sd,on Agency <br /> rm Approved OMS No 2050-Qp39(Expires 9 3&96) See Instructions on back of page 6 Deportment or To:K Substances CorArol <br /> rmt o+ ned for ase on elle()2prkAJ"writer Sacramento Cat-forma <br /> UNIFORM HAZARDOUSI Generator s US EPA ID No Manifest Document No 2 Page I Information in the shaded areas <br /> �WASTE <br /> p�MpgA�.Nof <br /> ¢IFEST �? r � � � � � �� + � �� ss not required by Federal law <br /> 3 Genu t r'J (XV i"]S� mg Address <br /> k ^f 3'4. <br /> 5004 <br /> `=,SIJ I`1CIJf ^-Aqr, F _ $ "M <br /> A:'k ?y#rTI• faE6 <br /> Gena oto.scone ( >1 I+ l _4 rs i s r=�s"�:""��s''fyfst ro 4 sp <br /> 5 Transporter 1 Comporsy Name 6 JS EPA ib Shmber [_ <br /> c rY1j a,_'Vv'J-1 <br /> ME <br /> ��, � +. <br /> + �• ,Ism �. ��. �. <br /> 7 Tr nsportof 2 Compainy,Name US EPA ID NuXber E { _ ,tK <br /> ��'.rfi • t sv sir sr t���..i 6 3 ".ti's..�-r'�'����.'�" <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number T�:� f:'I/! >" rYz iw y �i�In 1 44 % <br /> y <br /> c a Y <br /> J P,ii I. E,• -,,(I ��Y, »�# <br /> 3'ft a� <br /> 510}235-=139 _? <br /> Y <br /> Y +lra x <br /> 11 US DOT Description{including Proper Shipping Name Hazard Class and Ip Number) 12 Containers 13Total JA Unit _ti,�, <br /> No Typie Ouantsty, Wt/Val 1 watoe <br /> F 'j , <br /> urs <br /> EPA�ip <br /> N b SlollO tr an iu <br /> E <br /> EPA/O" <br /> A /ewr <br /> TT I ° t <br /> H <br /> R EPA/OIheT $,r <br /> a <br /> EPA/O*or 4 � <br /> s,s,��,�,,, e <br /> Nf �• =s '>? aL 9 "� "•^^" 'M COd1iT WatAas Listedtkq <br /> a"t3v JIt�L Yy*� <br /> a�+f <br /> �=w+ <br /> 15 Special Handling instructions and AdditiorwI Information <br /> I -L W- -T ]r'*" ' 1 t =1.r71 , a1 l-4,r1 <br /> t t i t;rr Z91- 1 rJ{sf!] r l-At 1_ f <br /> 16 GENERATORS CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified <br /> transport by highwoy <br /> packed marked and labeled and are in oil respects in proper condition for according to applicable international and national government regulations <br /> If I am a large quanMy generator I certify that I have a program in place to reduce the volume and toxicity of waste 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 if I ons a small quantity generator I have made a good faith effort to minimize my waste generation and select the best <br /> waste mono ement method that is available to me and that I can afford <br /> Printed/Typed Name ` _ Segrsatvre Month Day r Year <br /> l 1 Trans iter 1 c nowledgement of Receipt o/Materials <br /> R <br /> A Printed4eped Name ,�� Signatyrr. _ r/ �'"�- Month Day Year <br /> .✓—'f7 <br /> -J4 z,-/r� G*/f�G /1 r e_ <br /> 0 18 Transporter 2 Acknowled ement of Receipt of Materials <br /> TPrinted/Typed Name Signature I Month Day Year <br /> E <br /> R <br /> 19 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> Focil Cswner or rotor Certification of rete+ t of hazardous materials covered this manifest except as noted in Item 19 <br /> Y ���/,T{Y�Ped �^ie Signature r MontF, Day �Y}earr <br /> Irl ar i -5/177D ��! <br /> DO NOT WRITE BELOW THIS LINE <br /> e ;', :r �E-CS i- 5 __'i C CEr�E?a-:p !, <br /> C 8022A (1/95) <br /> ..at_rN cis wno c_'mr ^azarJOQS wa e iar <br /> 8200-22 produce complerc�j copy of this copy and sent it,- .says y i <br />