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Slate of California—Health and Welfare Agency DepartmentofHealthservices <br /> Form Approved OMB No.2050-0039(Expires 9-30-91) Toxic Substances Control Division <br /> Please print or type. (Form designed for use on elite 'itch typewriter). Sacramento,California <br /> nerator's US EPA ID No. Manifest 2. Page 1 <br /> UNIFORM HAZARDOUS information to the shaded areae <br /> WASTE MANIFEST c c a 0 0 1111413 2 g Document No. of �. <br /> S not required by Federal law. <br /> 3. Generator's Name and Mailing Address A. State MINIest Document Number <br /> JUP PESTNA QTIP TRUST <br /> W�T ' i [����/ r 2 B. Slate Generators ID <br /> }!9bnd`18i6?f hJJJE PW TF{flir! CA 9537 i <br /> ,d S. Transporter t Company Name 6. US EPA ID Number C. State Transporter's ID 1 <br /> ' C Y" 17 0 Q D. Transporter's Phone <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID - . "I <br /> o F. Transporter's Phone <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State facility's ID <br /> USX <br /> SERVICES <br /> �s / F /�� �Cr�f A i <br /> USX SER ICES O CALIF EJfl IA PWI LUM H. Facility's Phone + <br /> IURTCP:WILLNj LA 932W - <br /> t2. Containers 13. o A " 4. I. <br /> LL 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Ounniity Unit Waste No. <br /> Q No. Type Wt/vol <br /> U a' p fl RCPA r� +� State <br /> E C&I€OMIA #�GULATED WliST'E ULY (rUI RCPA O U 1 D T U 0 0 2 a Y 1EPAJ5jhjW <br /> N <br /> E b. <br /> n n <br /> A <br /> T <br /> O EPA/Other <br /> z R c. <br /> Slate <br /> EPA/Other <br /> W d. <br /> State <br /> z <br /> W � <br /> U EPA/Other <br /> W 1 <br /> 0 J. Additional Descriptions for Materials Listed Above i <br /> Z K. Handling Codes for Westee Listed Above <br /> 0 a. b• <br /> SOIL LUGAMIMID WITH OIL $ 60M <br /> C. d. <br /> t: 15. Special Handling Instructions and Additional Informal Ion <br /> r.1 -� <br /> 562 <br /> ,8 a <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are In all respects In proper condition for transport by highway according to applicable international and <br /> N <br /> national government regulations. <br /> f If I am a large quantity generator.I certify that f have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined <br /> 4 O to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the <br /> - present end future threat to human health and the environment;OR,i1 I am a smell quantity generator,I have made a good faith effort to minimize my waste <br /> 2 generation and select the best waste management method that Is available to me and that I can afford. <br /> 4 <br /> Printed/Typed Name Signature _ <br /> i `??fjttl Month Day Year <br /> RT 17. Transporter t Acknowledgement of Receipt of Materials <br /> 1 <br /> Z A Printed/Typed Name <br /> u N Signature Month Dey Yeer <br /> LL S <br /> O P <br /> W O 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> J— <br /> u) <br /> Q R 1 rinted/Typed Name <br /> U E SignaturePrinted/ <br /> Month Day Year <br /> ' z <br /> i 19. Discrepancy Indication Space i <br /> F v <br /> A <br /> C <br /> I <br /> L <br /> J I <br /> T 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. } <br /> y Printed/Typed Name Signature <br /> Mn,eih Day Year <br /> 8022 70G-22 A(1/88) <br /> :2PA 8706 Do Not Write Below This Line <br /> irPA <br /> (Rev.9-08)Previous editions are obsolete. j <br /> _ YELLOW: GENERATOR RETAINS <br />