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I Stole of Califorrre--Ehveronmreol Protection Agency <br /> Form Approved OMB No 2030.0039(Expires 9-30-04) Seo instructions on batt( of page b Deporm we of Toxic Substtrices Gone <br /> Weare print ter type Form dnrgned for use on eF7e(72prhfi)lypewreor Socramer" Cowonro <br /> UNIFORM HAZARDOUS I Gei1ef0tol`US EPA ID No Manifest Documeft No 2 Page 1 Information in the shaded areas <br /> WASTE MANIFEST is not required by Federal I w <br /> of � <br /> 3 Garraror s Nome and Madre Address <br /> = +"Aff <br /> LIM Wet Stralet Stud tan, C.A 95201 <br /> to 4 Goneralor`s Phone <br /> 3 Transporter 1 Camipmry Name 6 US EPA ID Number <br /> VAMM qD <br /> E. QMNS gT � = CAflfl76557370 <br /> Q7 Transporter 2 Company Nmna 9 US EPA ID Number <br /> u <br /> Q 9 Designated Fain Name and Srte Address <br /> eY 10 US EPA ID Number <br />�a Sf gtmy 33s F8ttecom, CA <br /> u OS31b6728 <br /> 11 US DOT Description(including P Shu 12 CoMmners 13 Total 14 unit <br /> Z ptiori{ ng roper Aping Name Hazard Gass and ID Number) No Type QuanW wt/vol <br /> a <br /> Y G 110ffik'� HAMM= WAM IAM <br /> E n Q 1 T I Z LI I'll 01 G <br /> aWo N b <br /> CDIV E <br />' C4R <br /> � A <br /> T c <br /> a R <br /> Z d <br /> Z <br /> W <br /> U i <br /> Uj _ I <br /> k <br /> W i <br /> d' <br /> I � <br /> Q T1s Spa ial Handr, Instructions and Additional Information <br /> ;7- <br /> .< = � SAFSY��]��PBpp�Ary3r3' )pBi�>�+� OPR PCO 'n r E CM. <br /> W MUM= � Irl;�>ILir� 209-7�R'L= <br /> H <br /> 16 GENERATOR'S CIERTIRCATION I hereby declare that the contents of the consignment aro fully and accurately described above by proper shippeg name and are classified <br /> pocked marked and labeled and are in all respects in proper conditm for transport by highway according to applicable fedora' state and international laws. <br /> If I am a large quantity generator I cer*that f have a program m pkKe to reduce the volume and toxicity of waste generated to the degree I have determrred to be <br /> t% ) economically practicable and that I have selected the practicable method of treatment storage or disposal currently available to me which minimizes the piesenf and fvture <br /> sn threat to human health and the envirormmop OR if I am a small quo"generator I have made a good faith effort to mimmsm my waste generahon and select the bast <br /> waste m nwdmd that a available to me and that I can afford <br /> Q Printed/ Nome Signature Month Day Year <br /> rr + <br /> V f U;E - ZAeJ4 "l ! I ..1 47 _/ <br /> Z T 17 T 1 Acknowled of Receipt of Mahwols <br /> LU <br /> Month Day yew <br /> M Prtmad/Typed Name Signature <br /> W s <br /> P <br /> ROEM EMM <br /> 18 T 2 Adawwf.d of Rompt of MaMmIs <br /> O ! Pnntid/TYl�Mom TSrgrialum March pay Year <br /> LLJ 79 Discrepancy hrd"hon Space <br /> F <br /> A <br /> Z C <br /> I <br /> I. <br /> I 20 F.Ift Owner or rotor Cerhhcahan of r.rcei of hazardous materials covered by this manifest ex t as noted in Item 19 _ <br /> YIrnitted/Typed Name Signature Monty+ Day Year <br /> DO NOT WRITE BELOW THIS LINE <br /> DTSC 8022A (12/91) <br /> EPA 8700._22 <br /> leliow GENERATOR RETAINS <br />