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Stwe oFColifornio—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30.99) See-In t UCtIOf15 Oft baC. .^pagfj§Z'157 Department of Toxic Substances <br /> Pleasp print or type. Form designed for use on elite(12-pitch)typewriter. ij 1Z � ' Sacramento,California <br /> _ 1. Generator's US EPA ID No. Manifest Document No. 2, Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS C A D 0 9 7 0 6 8 1 2 6 9 2 3 2 5 1 is not required by Federal low. <br /> WASTE MANIFEST Iof <br /> 3. GOLICaMe WY1SL'n ! A. State Manifest Document Number <br /> 1412 EL PIM LRM 990807'% <br /> o SIVICKTON CA 95205 (209)466-8924 B. State Generator's ID <br /> LO <br /> t0 4. Generator's Phone I I <br /> n <br /> CV 5. Transporter 1 Compony Nome 6. US EPA ID Number C. StateTronsporter�s ID[Rene '•s' <br /> CP 21st CERMY EHI N V D 9 8 0 8 9 5 3 3 8 D. Transporter's Phone — <br /> 0 <br /> O <br /> ao 7. Transporter 2 Company Nome 8. US EPA ID Number E. State Transporter's ID[Reserved.] <br /> Tronsporter's Phone' <br /> :.. <br /> MU 2lftnedfij]fy.Qjpr�Site Address 10, US EPA ID Number G.State Facili 's ID' <br /> Q "`r I r <br /> 2095 Nwlands_Dr. East <br /> �2 - rHFacility's PhoneC)00 ',_ Fernley, NV-89408 :. N V:D_9: 11 0;.8:>9 5 _3 .3,'g: _.; ,.,� • . :(,775th-:575-2760w-... <br /> LL <br /> C ) 12. Containers 13. Total 14. Unit <br /> cnU 11, US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number) No. Type Quantity WI/Vol L Waste Number <br /> MZ HASAMS VASTE, SOLID, I.O.S. (CHIOEB) ! U3111 PGIII Stole 181 <br /> 3 _G C..':i Pr EPA/C)ther <br /> d !J.;.. 0 O d d <br /> cl i N ICU 9ASA1DOQ8 i( R LIQUID State 134 <br /> DD E .ro'^rr�'•.r .t ,',t..,�,. ., -S•l.. .ae���s y,ih.td :zr..t'ra lv•�t�+:D,,v_,rFot�,�; M Cs .EPA/Other <br /> A ,0 ® <br /> C. <br /> State' <br /> o T <br /> oCo O <br /> R EPA/Other <br /> w all State <br /> t— <br /> Z <br /> w <br /> U EPA/Other <br /> Zw � �y� <br /> }s NcIprs�D�ripfio �I�'_•5lA812 (1) bj 31!131-!l;� lB�;�, Handling Codes for Wastes listed Above <br /> dap���+a����+a��cT�7CCp..■■�ftrolta���p �t�� 7 a. 6? b. <br /> O ',, (1al YiYYDII•WWOY n7VItt`'.•'.-�S16W1:±(,G),'!' - �Jl� <br /> LU <br /> C. d. <br /> J <br /> 0 15. Special Handling Instructions and Additional Information of 101.14:BOU BlB1GSIICT MPOISS, CALL (323). 116-6233 <br /> a IM ROM PIMClIVE MMIG. MISUCI MPMSB ?B011 (811) 648-9931 (115) 515-2111. <br /> Z <br /> w <br /> t- <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> Q marked,and labeled,and are in all respects in proper condition fo transport by highway according to applicable international and notional government regulatiors. <br /> U <br /> J If I am a large quantic generator,I certify that I have a pro ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economicoll <br /> J y <br /> Npracticable and that I have selected the�rocticable method o treatment,storage,or disposal currently available to me which minimizes the present and future threat to human healt <br /> and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that <br /> available to me and that I con afford. <br /> OPrinted yped Name Signature Monlh Q Day Y <br /> Z V C/ <br /> w T 17. Trans otter 1 Acknowledgement of Receipt of Materials <br /> = p Printed/Typed Name Signature Month Day Y <br /> WN <br /> P <br /> tL 0 18. Trans o er 2 Acknowledgement of Receipt of Materials <br /> 0 R Printed/Typed Name Signature Month Day Y <br /> T <br /> N E <br /> R <br /> V19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> f 20. Facility Owner or Operator Certification o e ei t of hazardous materiols c 'red 61 this manifest except as net 9d a 19. <br /> T /Typed Nome S'gnature M nth Day�J Y,I <br /> Y Zk3Z ( al�r D�O <br /> DO NOT WRITE BELOW THIS LINE. <br />