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State of Cahfomio—Environmeniol protection Agency <br /> Form Approved OMB No 2050-0039(Expires 9 3496) See Instructions on back of page 6 Department of Toxic Substances Control <br /> Please print or type Form designed for use on elite(12piKh)typewriter Socrame ilo California <br /> UNIFORM HAZARDOUS I Generators US EPA ID No Manifest Document No 2 Page 1 Information in the shaded oreas <br /> T is not required by Federal law <br /> WASTE MANIFEST L {l U Q O S (} In F3 ] G of <br /> 3 Generator's home and Meiling Address Patti nsF <br /> r "s <br /> n 3450 LL ^aN?NO CERES, CA 95307 St` 411- <br /> 5 <br /> 4 Generator's Phone , rEli <br /> Ig {2?�#) X37-0771 Transporter I Company Nome 6 US EPA ID Number `T R� its <br /> 00 <br />'a 7 Transporter 2 Company Nome 8 US EPA ID Number ' Ep <br /> ij��fJ,11 ! ! 1 7 f 4o-_ <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number j = Who"AME<RICLEAN, INS;. 4 Mft F"22r5170r�iA�LrC�Oir,1tID DR. s��1 r�riw�jh r� n +� �] CpqC� ry � �I' � <br /> r V SJ i_VER SPRTE 7v7 N 89 429 'Y �� iJ J ri G .7 7 G `{ Ct ry <br /> I I US DOT Description(including Proper Shipping Nome Hazard Class and IA Number) 12 Containers 13 Total 14 Unit <br /> No Typo Quantity Wf/Vol „{ <br /> 1= NEON RCRA HAZARMUS WASTE LIQUID <br /> E <br /> 00 <br /> N b <br /> v R ' <br /> T <br /> R <br /> d <br /> LU <br /> A FR< r d " wa <br /> � b <br /> owe r <br /> 15 Special Handling Instructions and Additional Information PICK—UP, AT: 76q E. CHARTER WAY <br /> WEAR PROTECLLTYVE GEAR A � STOCKPI ;, CA <br /> 24 HR FAC11JTTY 702-577-9001 <br /> ' 24 HR GE NEAATOR 209-537-0773 <br /> 1 16 GENERATOR S CERTIFICATION I hereby declare that the contends of this consignment are fully and accurately described above by proper shipping name and are classified <br /> packed marked and labeled and are in all respects in proper condmon for transport by highway according to applicable international and national govemment regulations <br /> If I am a large quantity generator 1 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 /> a 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 /> sq threat to human health and the environment OR if I am a small quoP146 generator I have made a goydiaslh effort to minimize my waste generation and select the best <br /> waste management method that is avaJable to me and that I con afford <br /> Printed/Typed No a /� Signature' / Month Day Year <br /> sZ 17 Transporter 1 Acknowled emenf of Receipt of Materials r �' <br /> A Panted/Td Nome r Signature f f Month Day, r Year <br /> - f' f)e-)�') ( te-/ <br /> w 0 18 tans o ter 2 Acknow ed sent o{Recei 1 of Materwls l <br /> R Printed/Type me / f Signafure �' Month Day Year <br /> si T / <br /> 19 Discrepancy Indication Space <br /> U F <br /> A <br /> C <br /> i <br /> L <br /> 20 Facility Owner or Operator Certification of receipt of hazordous materials covered by this manifest exec t as notecil in Item 19 <br /> Panted/Jyped Nome Signature Month Day Year <br /> i <br /> / DO NOT WRITE/*OW THlYNE— <br /> ISC 8022A (1/95) <br /> Green TRANSPORTER RETAINS <br /> A 870Q-22 <br />