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re of Californir>—Cmm'ronmemd Prot AyaryToxic <br /> rm Approved OMB No.2050.0039(Enpires 9- 94) See Instructions on back of, ,e 6. D.pamnsa of umm sabnaKH Control <br /> plense prim or type. Form designed for use on elite(12-piWr)�ae, �R/ Sacrama+to.California <br /> T(n)zAC11DC4>e111jC)11 <br /> ata's US EPA ID No. Manifest Dommeat No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS -.1 �? a rat required by federal law. <br /> WASTE MANIFEST �U � of <br /> 3. Gerwrator's Name and Mailing Addmss' <br /> O <br /> 4..Geseraror's Phone <br /> m <br /> ro 5. transporter 1 Company Name 6. US EPA ID Number <br /> W <br /> M,..,Nv 7. Transporter 2 Company Name8. 09 EPA ID Number <br /> W <br /> 0 9. Designated Facility Name and S'ae Addren 10. US EPA ID Number <br /> ME <br /> U 12. Centel. 13. Total 14. Ihnif <br /> Z 11. US DOT Description(including Proper Stripping Name,Hazard Oars,and ID Number) No. T wt 01 <br /> 3 0 i`• , <br /> C E T <br /> m N b- <br /> °D E <br /> n R <br /> A <br /> 8T <br /> w o <br /> R <br /> w <br /> Z d. <br /> U <br /> W <br /> N <br /> Z <br /> a <br /> N <br /> W <br /> C <br /> J <br /> Q <br /> 0 15 Specht Handling Inshuctimss and Additional Information - - <br /> I— E.. n E ! :l.illtes`1 s, p .. isfl�jPf• bj-)ts , <br /> Q , ntur j � v 1: ti lv <br /> 16. GENERATOR'S CERTIFICATION: I hereby dedaw Haat the caatmH of the comignmenf are fully and«curalaly'�describad abate by Proper shipping name and ars clasdfied;. <br /> Qpocked,marked•and labeled,and am in all respects in proper randilian f«transport by highway according to applicable federal,stale and international laws. <br /> Ui' <br /> If I am a large quantity generator, I cedify Haat I hove a program in place to reduce the volume and fozkil 4—generated to the degree I haw determined to be <br /> economicaly, practicable and that I haw seleand the practicable method of treatment,storage,w disposal cu tzmg ble to me which minimizes the present and future <br /> threat to to human heahh and the environment;OR,'d 1 am a smog quantity genealor,.Lhasa made a good fdlh effort to minim¢e my waste generation and sdM.the best <br /> w <br /> ement method that is owitobleho me and that 1 con afford. <br /> t5E� <br /> O Printed/T ped Nome Sigmtore Moab' Day—: /Never <br /> U T 17. Tani rtor 1 Acks owled neater-of ReceiptMaterial ^ ' <br /> R {{ <br /> (w H Printed/Ty ;Name s r_ \ r i _ �� \ <br /> � , <br /> is ; ,, ; �F� 1 <br /> W <br /> 0 <br /> w 16. Tram r 2 Acknowkd emmf of Receipt of Materials <br /> w r Prin ed/Typod Name Signa-re iv,' MONK Day Year <br /> U- <br /> 0 e <br /> Q <br /> w 19. Discreponey Indication Space <br /> N <br /> Q F <br /> U A <br /> I <br /> Z <br /> _ <br /> L <br /> 1 20, Facil' Ow«r or O rat«Certification of r« ou <br /> receipt of hamrds materials covered b st this manifeezc as noted in Item 19. <br /> s T Printed/Typed Name Si re Month O � Day Year1 <br /> `' ✓"M'V/�p I Z 3 <br /> DO NOT WRITE BELOW THIS UNE. <br /> OTSC 8022A (7/92) r uernpo oprewc <br />