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nmanralrroteCttonAgency <br /> �. �oproved C,1hE Na. ;050-0039!Ehptres 9.30-49} See Instructions on back of page b <br /> r'ecse n'r n or rarm_4pe, Fdes,oned g +for use an eiiie{I7-Pitch)typewriter. Department al To,vc 5a65rances <br /> Sacramento.Colifornta <br />• } ,` UNIFORM HAZARDOUS I. Generator's US EPA ID No. Manifest Document Na. 2. Page I Wormotion in The shaded creas <br /> WASTE MANIFEST r'� ` J L is not required by Federal in-. <br /> 1 `�1 <br /> �� � <br /> 3. Generator's Name and Mailing Address of <br /> U tcigMoAifestD&vinentNurn6 � <br /> �N + !A <br /> Ski 'Gerseralar D : F1^"�Fr rat �,rZ _; <br /> 4 Generator's Phone f-,' }L.{' r i4�' 77 - <br /> n ; 5. Transporter t Company Name b. US EPA ID Number <br /> Co <br /> O7. - <br /> Transoorter 2 Company Name s �• <br /> / A ID EPNumber Jr-Strite"Trpnsefi7 -.� 'r <br /> , •i�.�#zq- <br /> �� +k+��.� v h `�s' s t•.2?q',c:�+. nth- 1 <br /> Q f 'i arts n r'j <br /> d:s7 r- Ani n� u �t� r j J r <br /> • V 4 Design/a red Facitiry Name and Site Address/ 10. U5 EPA ID Number Ca �5tote aetli.,sf1D y <br /> Z. <br /> 17d <br /> d i s Phosi'12-1 lo 6 <br /> n <br /> US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Tolol 14. Unit + <br /> No. TypoOuansity Wt/Vof Wasfe Nusebe <br /> LO <br /> Stare:' ' <br /> 00 31 c / <br /> ! ! I EPAP Other. <br /> .: <br /> m Stare <br /> OrA I O <br /> s I EPA/Other4z=,.,- x' <br /> Stare, <br /> EPA/Other, <br /> 4 <br /> * � J Additional Descriptions for-Materials Listed Above- <br /> L _ 1{Ya fy� & K fandGng Codes for Wastes Listed Above�, ya X, f <br /> ad �yLp a''y <br /> a a�t - ? r syei r +:�+ � A•�- - s 'S g ts-s. e k.t e - - <br />. Q I - - . w , � irwits�s"y� may„ Kkwa � ° :>�a t•r'�'� t� I`r�-,, sus d .t.f f•t:, 3 - <br /> - <br /> .rs: <br /> 0 15. Special Handling Instructions and Additional Information <br /> F ' <br /> a <br /> li <br /> 4 JI <br /> Q` 16. GENERATOR'S CERTIFICATION: I Hereby declare that the Contents of this consignment are fully and accurately described above by proper shipping name and are cfassilied,packed, <br /> I marked,and labeled,and are in a!I respects in proper condition for transport by highway according to applicable inrernationol and national government regulations. <br /> V; <br /> �i . <br /> I If I am a large gvanttty generator, I certify that I have a program in pEoce to reduce the volume and toxicity of waste generated to the degree! have determined to be economically <br /> N 9 practicable and shot I have selected the�raUicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to Kumon heolrft <br /> 9 ana the emtranment:OR, if I am a small quantity generator,1 have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> a I t ovaliable to me and that I can afford. <br /> 0 <br /> } ;Printed/Typed Name I Signature Month Da av^ <br /> VZ Ll r <br /> W <br /> D I T ti 7. Transoorter i Acknow€ed em t of Recei t of Materials f 1 , <br /> A <br /> I :printed) sped I�pme �""- Signature <br /> `��� Months-- Day. ,Year <br /> N ) t �/� <br /> R 'n -Q / s.,' - / v�,t 1.,J` j J � ! i <br /> P <br /> z 0 fI 3. Transoorter 2 Acknowled em4nt of Recei t of Materials <br /> 0 <br /> rple <br /> Pe <br /> 1 d'/T YPd Nome Signature Month DaY Ye or <br /> E <br /> L w <br /> Q <br /> V '19. Discrepancy Indication Space <br /> w R <br /> F <br /> A <br /> C E <br /> I <br /> 1 20. Facihtv Owner or Operator Certification of receipt of hazardous materials covered by this manifest ecce t as noted in Item 19, <br /> T PrimedlTyped Name 5ignature Month Day Year <br /> �* Y <br /> DO NOT WRITE BELOW THIS LINE. . <br /> 1 DTSC ED22A 14/97) <br /> !i EPA 3700-22 Yellow GENERATOR RETAINS <br />