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, <br /> I <br /> Stare of Coldornron <br /> —15mromeniol PrWlhcho,Agwr , <br /> Form Approved OMB No 2050-Mg(Expers 931194) See Instructions on back of page 6 <br /> Pleme Prim or type Fenn despised kr we an eMe(12pach)>ypewrrler Delco:tnrem of toxic Su bstonces Coni <br /> Secromento California <br /> UNIFORM HAZARDOUS I Generators US EPA ID No Monsfast Document No 2 Page I Information m the shaded areas <br />' WASTE MANIFEST Q O O i15131118 1 0 0 0 0 4 of 1 +s not required by Federal law <br /> 3 C,aneratar s Name and Moiling Address <br /> �M ICS CCWMY <br /> Em VWt Webbm �Ss/t�met,, Stocktim, CA 95201 <br />' &n 4 Generators Fftane ( w7 948-1.231 <br /> 3 Transporter 1 Company blame 6 US EPA ID Number <br /> CP <br /> $e GOM mar, INC. 4 D a 7 6 5 5 7 3 7 0 <br /> J <br /> J <br /> U Fransportar 2 Company Nasrta 8 US EPA ID Number <br /> a <br /> 9 ed Factleie a�sd Sde Address 10 US EPA ID Number <br /> O e7Lri' Y1faLS <br /> r, 13333 RWNSY 33, Patterson, C► 95363 <br /> CADQ83166728 _ <br /> 11 US DOT Description(mcludotg Proper Shipping Name,Hazard Class and ID Number) 12 Containers 13 Tota! 14 Unit <br /> a � � No <br /> kuT Wt/Vol <br /> G <br /> oE b OD1T T �( Dd s <br /> 4E <br /> IC4 R <br /> A <br /> g O c <br /> HCl d , ¢ <br /> L "Y"E"°~ rL�"!' :"r .i� _ ± cLL ,.- . �i ,J"I `.S`h1 " •.� ;44 <br /> 75 Speaai Handling Instructnom and Additional Information <br /> a � STM AHI APPROPRIM GM. <br /> EMMGEN= CBCT BOHM 209-94&-= <br /> 16 GENERATOR'S CERTIFICATION I hereby declare that the contents of the consignment are fully and accurately described above by proper shippetg name and are classified <br /> packed marked and labeled and aro in all respects in proper condmon for transport by highway according to applicable federal state and international laws <br /> If I am a large quantity generator I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economncally practicable and that I have selected the practicable method of treatment store or disposal <br /> A threat to human health and the emnronmeet OR d 1 am a small geod forth effort <br /> available to me which mmnmera on present mid future <br /> quantity generator I nava made a good faith effort to mmnmaca my waste generation and select the belt <br /> waste man° rrtatitod that is available to me and that I can afford <br /> P" 'T L f ame <br /> c. f u�P,v�J s srgnahrDay <br /> u R 17 Trwns arter 1 Acicrgwled ement of Recmat of Materials <br /> 11 <br /> 11 Pn�med/T�JQyed NoneSrgnuepViri <br /> {� 3 3'1 40"3 <br /> 0 18 Transporter 2 Acknowled of Receipt of MtstenaB <br /> Prmted/Typed Nome Srgrtature <br /> e r month Day Yaw <br /> 19 Discrepancy Indication Spaces <br />� F <br /> A <br /> C <br /> l <br /> I 20 FacIrty Owner or r Certification of recei f of hazardous materials covered tilts manifest excect as rated in Item 19 <br /> T I Printed/Typed Name Signature <br /> Month pay Year <br /> DO NOT WRITE BELOW THIS LINE <br /> C 8022A (12/91) Blue GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS <br /> 8204-22 To P O Bax 400 Sacramento CA 93812 0400 <br /> a <br />