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<br />orre Approf4id OMb No, 2050 -MI? (EAplres 4-34.94) S1struCTionf on back of
<br />igasoyrirlt or,". Form designed for vs& on ef8e (12 -pitch) fypewrifer,
<br />l UNIFORM HAZARDOUS 1. 0 Gonerpl°`'' US EPA ID No. Man/fest [1n<unlunl No, q
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<br />I1 I WASTE MANIFEST I I f131 5/ 1 ()1
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<br />May 15,95 10:43 F.02
<br />beporfiIm vl loan :uerranees w.... v,
<br />—5ocromenr°, Collforr,ia
<br />2. Pupc 1 Inir,r�nation in tho�shodesl arca! ••
<br />f +: r;,t req!dred by federe.l low.
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<br />J. Geaeratoi c Name and Moiling Addross h,1 " 16tt)064eat fumLbr r
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<br />4. Gemrotor'i Phone
<br />5, Iranspoeler 1 Company Nan» 6. US EPA ID Number rn�i portolt D
<br />w sT c1nL0 810 011LI Pi5L
<br />7. Transporter 2 Company Nome ..S. US EPA ID Numbor
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<br />9. Cesignole<f.ForilityvNama urrd ` petdres 1 $ tP ID Number tak+ FdSltrfy't iP 1 d,
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<br />13331 N. HWY. 33 . ` n4 r�+.+,")
<br />pA.TTI~R50N, CA 9536.3 _—L' AI 101 .1..3 1 6 7 2 $ ..:;,'rM BCIo 7� 44
<br />-' 12, C-onfaineers 13. Mal 14, 11 1 '
<br />It. US GOT Description (Including Prorwr Shipping Nome, Hacurd Clots, and ID Nvilibe-r) i
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<br />NON RCRA 11AZARDOUS WASTE LIQUID C
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<br />15. 5}vciol Handling InalruUnNls and Additional InlwmufiOn
<br />24- HR. EMEFLUMCY CONTACT! PICC #1—(800)-•874.4444
<br />24 HFI. P.MERGENCT RESPONSE: CHEM TEL INC..01—(800)-255-•3914
<br />APPROPRIATE PROTECTIVE CLOTHING S RESPIRATOR.
<br />16.
<br />pocked,
<br />mOR'S�Cand lobljl d, and orretInkall a ipbirstintproper u,ndilioo for transportflby highwt ore luy a coidingtelyt.a tl plira6le fedc. ol, state (a by -dsntcm Hia Kd laws,
<br />c'rr. Aavilird,
<br />11.1 am o {orae quantity generator, I certify thol I have a program in plore to reduce the.volvme and toxicity of wa-le Wneroled In till. deyreo I huve J�dcnu6,ed t° l.r:
<br />economl<olty practic<sbio and that 1 hove selaclet♦ the prmt;cable method of treat metit, storage, 'or disposul Lwltrtly avallobte to "I" d+64+ mine, •.,rs she prnsnnt and ful.,w
<br />threat to human heulth and the orw ronment, OR, if 1 am n stall quoulity generator; I ho madc a good (oith Ifori to minimi,5e Illy wostc pcncratiwf arld soled 16r• hrst
<br />waste monngrtment method shat is ovaila6le to too and that I con afford,
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<br />17..Transor . A knuwled cmenf of Rtccipr of Matrriols ,u,.__ •- . _ - .. .. I ..--_— "-- --
<br />Ninecd/1 A N � Slpnature
<br />18. Irons er 2•Acknowled�ernern
<br />Month If Uoy
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<br />Signature r
<br />yped Name
<br />Printed/T Y
<br />19. Dutra+uncy I,+dicolion Spon
<br />-,?0. Facllrl�(7wner or Operator Certif' .otion of rr..cei I of hatnrdoys materials covored by fh^]S Manifest eKc 1 es not in Item 14.,.,
<br />Printed/ Typed No a Si(yre- r
<br />W DO NO WRITE ELOW THIS LINE.
<br />DISC 4022A (7/97)
<br />.. .. (,rs,.nth_ . _._ 0(.,y.. y„ars
<br />Grcerr tfAULCR RI.TAINS
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