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State of Cahfo"da--Enviromnentol Prvre[tbn Age icy <br /> 1Ia4^ rowed OMB No 2050-0039(Expwm 9-30.94) See Instructions on back of page 6 Deparmi*0 of row Subaan<e,Cannrc <br /> Pleose pAnt or type Form designed for use an ei(12pArh)l —iier Sacremereo California <br /> UNIFORM HAZARDOUS I Cienerator's US EPA ID No Manifest Document No 2 Pape 1 htortnohan m the shaded areas <br /> e • is not required by Federal law <br /> WASTE MANIFEST of <br /> 3 Generator's Name and MaPeg Address t• " `-" 1 <br /> *14W I.A1114-1 1 ANYrUN Ll VD 200 <br /> W I ha?- <br /> W) 4 Generators Phare00 <br /> ( ) <br /> a S Transporter 1 Company Name b US EPA ID Number <br /> °° Lm" oiMd!"FJM ,mss" ' <br /> _ 21 <br /> . <br /> Q I 7 Transporter 2 Company Name 8 US EPA ID Number FIG <br /> Z4 � <br /> V' <br /> Z �Q 9 Designated Foci*Name and Site Address 10 US EPA Number <br /> CSO p'{; r'nh i 1 t to,ON EW1 I kf[)F'Oh <br /> r- <br /> Q <br /> U 12 Containers 13 Total 14 Unit <br /> Z 11 US DOT Description(including Proper Shipping Nasse Hazard Class and ID Number) No Type Wt/Val <br /> rot)N W.HA HAZARD z> VVA:�I E i_ I(A l I tl <br /> 3 G `04A 6dI III PF-IF(jl[ Ell,II IjyDF(jU_AFbiLN, <br /> ) <br /> n E <br /> C005 N b <br /> 00 E <br /> cIVv R <br /> A <br /> o T c <br /> ce O ; <br /> cc <br /> R <br /> ru <br /> t" d <br /> Z <br /> uJ <br /> U <br /> a <br /> H <br /> su <br /> cc <br /> a <br /> 'Z 1 S Spaual Handling ins ruchanti and Additux Information <br /> 0 24 IdU A EfiEHGENCY HESPUNbE "IBER I t 600) 399--435 <br /> Z <br /> LU 11A PROFILE #141—P <br /> FSITE ADMESS: K I NG I'—'--LAND RESOR I- 11530 W. E I GHI M I I E ED- STOCK TON (A <br /> j 16_ GENERATORS CERTIRCATION• I hrtreby declare that the corsimts of this consignment are fully and accurately described above by proper shipping name and are classified <br /> packed marked and knbelad and are in all respects in proper condition for transport by highway according to applicable mFertwhawi and national governmerd reguktlans <br /> U _ <br /> j If I am a large ga entity generator I certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I hove determewd to be <br /> 1_ economically prachcable and that I have selected the practicable method of treatment storage or disposal currently available to me which rnwwmzes the preset and future <br /> d meal to human heal*and the snvrrori naris OR d I am a small quantity generator I have made a good forth effort to mmmme my waste generation and select the best <br /> waste method that is available to me aid that I can afford f I ES <br /> QPrmted/Typed Name Si rc r �r Mouth Day Year <br /> Z R 17 Transporter la AcknowleAgernitint,of Recesof of Materah <br /> C� A Printed/T me Signature Month Day Year <br /> OC S J ,� r ) < <br /> O 18 T 2 Ackno%" of Rec of Mental i r <br /> su Trod/Typed Name Signature Month Day Year <br /> LL. ` <br /> R <br /> LU 19 Discrepancy Indication Space <br /> V) <br /> a F <br /> U A <br /> Z I <br /> L <br /> 1 20 Facildy Owner or rotor Certification of receipt of hazardous materials covered this manifest exc t as rated in Item 19 <br /> T Premed/Typed NomaSignature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DISCs022A (9193) YeOo,v CE,E"�Tia �:TliNS <br /> EPA 8700-22 <br />