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' State of Cofrfor"" - nranmereol Protection AqW Cy <br /> Foran Approved OMB No 2050-Mg(540M 9 3694) See instructions on back of page 6 print or pOparsmerA of Tonic Substances Carr <br /> Please type Form desiQmed for use on elBe(12pdch)fypww rser <br /> Socrianento Cakforreo <br /> UNIFORM HAZARDOUS f I Gone arors US EPA ID No Manifest Documoat No2 page 1 Information m the shaded areas <br />' WASTE MANIFEST e1 Alis not required by Federal law <br /> , coo � zs3zgz o a a 3 of 1 <br /> 3 Cse!erator's Name and Mankng Address <br /> = Cxwj= <br /> L} Vwt StMet s Sys Cd 95M <br /> 10 <br /> CC 4 C*enerator's phone40 <br /> S TrartspoAer 1 Company hlaae O US EPA ID Number <br /> voa <br /> who= ILgo= X=VA =- I G 076s57370 <br /> Q 7 Transporter 2 Canhpairy Nam, 8 US EPA ID Number <br /> U <br /> 9DMMPm ed Fad Name and Sde Address <br /> 10 US EPA ID Number <br /> kir- <br />�Q �, ;� Ch 95W <br /> kNoIJ <br /> GAD083I66728 <br /> Z 11 US DOT Dagnptran(hn WvV proper Shipping Name Hazard Class and ID Nomber) �2 COnkn"1°rs 13 Total 14 Unit <br /> = <br /> T VW/Val <br /> CV3 a K*J-� HAZARD= W= LIC�I3 <br /> 00 NE 1019_LI _TIT6jY1,610 G <br /> N b <br /> 4 E <br />' R <br /> A i <br /> in T ` <br /> .� O <br /> IW0 R <br /> z d <br /> su <br /> V <br /> W <br /> N <br /> W � <br /> a <br /> O 15 al Hand Instructions and Atddrtronal hrformotpop A�n� ��s Ta to r �t7 <br /> AM xirT�iiiL� f~/N irQ..tysi. <br /> z ENEBGR= CCNL= NUN= 2p9-94&- <br /> W <br /> x <br /> —+ 16 Gi8t1W/4TOR 5 CER <br /> TIRCATION I hereby declare that the contents of the consignment ore fully and accurately described above r <br /> VJ by Proper shipping name and are classified <br /> packed marked and labeled and aro in all respec73 in proper condition for trmisaort by highway according to applicable federae state and rrnterrianonal laws <br /> Ifrnti <br /> large quaty gwwrotor I certify that rs 1 go" a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> eearwrnrcai <br /> ly practicable and that I have selected the practicable melfnod of treatment storoge or disposal currently available to me which mhnrmizes the present and future <br /> V) threat to human health and the wiviron mew OR if I am a small quarntity gwieratar 1 have mode a good faeth effort to minimize my waste generation and select the bets <br /> wastemanagement nwrhod that is available to me and that I can oftecd <br /> O P <br /> /Typed Nome <br /> SWnq <br /> Day <br /> T 17 Tr 1 Acknowled of Recur of Matergls <br /> W ■ <br /> S <br /> �g r . -lei, TOJ <br /> 31 5f <br /> W <br /> 0 18 T r 2 A of Racer of Materals t <br /> O : Pmted/Typed <br /> tar"' Swnatsr <br /> W ro ! Marnlfn Day Year <br /> LU 19 Discrepancy fadwohon Space <br /> V P <br /> A <br /> Z C: <br /> I <br /> r <br /> 1 20 %OldyOwner or gperatorCertification of rsceh of hamrdaus materials covered !tin manrfest ex as noted in Item 19 <br /> T Pima /Typed Name <br /> Y Signncftrs <br /> Mash pay Year <br /> DO NOT WRITE BELOW THIS UNE. <br /> I DTSC 8022A (12/91) <br /> iI1 EPA 8700✓22 <br /> Yellow GENERATOR RETAINS <br />