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2 111 ei11a�PratKtt ��Z�.!, '4"iq �M1 e,r � �0.r».i�:' � ....X3* y,) i 4' h�a M1.� <br />'ale Gol+tornlaim iro ion JeIkY a t i; k •�•« +.tie f 7L <br /> 1B No 2050-00391Expues9 30 99} see Mstrictalons owlac of page 6.t ' `5�� � ,`�jn1 f;Tnxic561is'L is nlrol <br />'I earaaa pistil Form designed far use an efile(12pikh)typewriter Socrameata,Caltfornia <br /> 1 enerators US EPA ID No Mon&st Document No 2 Page 1 1nFormahon+n the shaded areas <br /> G <br /> UNIFORM HAZARDOUS Is oat required by Federal low <br /> WASTE MANIFEST of <br /> Ax t[ed e�tlVyln } ! <br /> 3 Generator s Name and Mailing Address I,A y ` ' � �7 t�Y <br /> //++'� l�Y�+'► /�✓I/�if'�Jr4" r.+I� • qq� B State CoonerawsID <br /> /!(/r • � Y J , +� <br /> QQ5i A Generalar's Phon } <br /> i 5 Transporter 1 Com ny Name 6 US EPA ID Number C StahYrans rs ID essrved -, � r`^� <br /> CA. 1," D Transporter s Phone 11 r ,r <br /> 7 Transporter 2 Company Name 8 US PAD um r E State Transporter's ID Ilteserved I <br /> F Transporters Phone <br /> ' pesi�nated <br /> Foci[sty Name and Site Address 10 US EPA ID Number G State facility's Q <br /> 1v1r0 �/ f <br /> H Fac+i s Phos (O- �f +� <br /> 71/7 �74V'O <br /> 12 Containers 13 Total 14 Unit <br /> 11 US DOT Description(including Proper Shipping Name Hazard Class and ID Number) No Type Quantity Wt/Vol I Waste Number <br /> a Sfa t <br /> fJj <br /> r � / r � � EPA/Other i <br /> &4Ld <br /> E State <br /> N <br /> E EPA/Other <br /> r R <br /> Y A Stats <br /> T <br /> a 0 EPA/Oiher <br /> — R <br /> Stam <br /> d <br /> r <br /> J EPA/Other <br /> J <br /> JK Handling Codes for Wastes Listed Above <br /> nIII aaal passr+ptions For Materials Listed Above <br /> A#Vc�.(�/ a <br /> 3 <br /> J <br /> L c <br /> J ` <br /> 2 <br /> 7 <br /> 15 Special Handling Instructions and Additional Information <br /> 6 7 I <br /> J06 <br /> r /V-70 <br /> .y ci F, c 4 _ a <br /> LI <br /> 16 GENERA R'S C10FICATION I fiereWdoclare that the contents of this consignment are fully and accurately described above by proper shipping name and ore classihed packed <br /> S morked and labeled and are in all respects in proper condition for transport by highway according to applicable international and national government regulations <br /> J <br /> II l 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 economically <br /> i practicable and that I hove selected the practicable method of treatment,storage or disposal currently available to me which minimizes the present and future threat to human health <br /> A and the environment,OR,if I am a small quantity generator,I aye made a good faith effort to minimize my waste generation and salad the best waste management method that u <br /> x <br /> available ro ma 13.A#at can rd <br /> Ji - Month Dory Year <br /> kr <br /> Z ... ' fin S i <br /> Lj <br /> TR 17 Trans rter 1 Acknowled em 1 of Receipt of atenaIs <br /> C? th Day Year <br /> 11 Pnn Typed Name lure <br /> S <br /> i p l8 rens rte 2 cknowlad ement of Receipt of Materials <br /> O R Mantis Day Year <br /> T Printed/Typed Name Signature ! <br /> L E <br /> Q R <br /> V 19 Discreponcy Indicohon Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> f 20 Face'Iry Owner or Operator Certification of receipt of hazardous motenals covered by this manifest except as noted in Item 19 <br /> ntad/Typed Nome Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> Blue GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS <br /> To P O Box 400 Sacramento CA 95612 0400 <br />