|
06/02/2005 10:23 FAX 510 614 8396 PARADISO MECHANICAL 2005
<br /> State of Cellkmia—Environmenrol Protection A�an�y ..See Instructions on back of pL 4 � Department or Toxic Su6stanros Control
<br /> Form Approved 0I�.'�No.205p�039(Expires 30-49}k 6gcramenic,Caltfernlo
<br /> plaale print,or typ6 Fdrm desibned For use on slim(12•pilch)rypewrfler,
<br /> 1. Genarater's US EPA ID No, Nlonife9 D01-6nl No. 2. Page 1 Informal on In the shaded ar*gs
<br /> FA, 69ineratDr's
<br /> M HAZARDOUS isnot required by Federal law.
<br /> TE MANIFEST �� A C3 '? 'Y of
<br /> A. $talo hhadi{es1•Dgcurnent Ntirnber.
<br /> ame and Moilln®Address 33
<br /> �tl>�.+�uLr '��, 8}7�JI}l,F "1°i (tq I
<br /> f�0F!"3�!` "'� , "1°Y� 7r's�Ln hone
<br /> 5, TmnsporW 1 Company Nome
<br /> 6, US EPA ID Number C. Slate Trmnporre6 W rRoMCMd•I
<br /> m r a D.Yton' tier s P one . ' I
<br /> O lACtlkkA9 srmje ElLva ' 7ClwP.'.. er ,k � � � .� 1p µ
<br /> Transporter 2 Company Nome
<br /> B. US EPA ID Number F, SltireTranepartifr'i ID'Ras ;)
<br /> p_Transportels phone 1
<br /> Jd Silo Address 10. US EPA ID Num6or O tele ° ty ID
<br /> �z [aQa� tr_ �talrr�a �r;r�rr` -
<br /> 71 W
<br /> CI'IN9�"'fazm' IgA 00d2l2 7 tj s� �> 3 ,3 M„Paellrtys'?heirs I i•
<br /> ;~ 1.
<br /> :0
<br /> 12. Containers 13. Total 1 A, Unit
<br /> J
<br /> 1. US DOT Description lincluding Proper Shipping Nam*,Hazard Dass,and ID Number) No. T Gtuenli Wl/vol I. Wavle Num'04,
<br /> Stem
<br /> 1, T T rA�0
<br /> E
<br /> amo b
<br /> E EpA/Ofhdr .
<br /> c A State .
<br /> e.
<br /> 0o O EPa/Cr}her.A
<br /> R -Slate
<br /> LU d.
<br /> Z 1rhAl�her:
<br /> su .y ,K. Handling ryl+Fos.Wbi r'44strad Abaly'e '; •'� 1ti`.''•.,n,' '
<br /> .�' .d r''. �,; .:..r. /.,h.,l.(,I�I,yt' r /.� :r�i�Yn�•yry+;''u?yM•s �Xy'?'xdn,i,�, _a,yrb;}p �Kri'r.r• r�Trr,^ 1�,9Sn•e
<br /> owe
<br /> O 115. S�pe"cial HandlI InstrueNvni and Additional lnFormoNen
<br /> � ati rroL31tB In� � llli�tl:Lit iblt;bf07 +M.a`"�4��3Q#td 7'm>�'1'`0�� et
<br /> Q
<br /> J 16, GmEBATOR'g CERTIFICATION: I horebydeelare Ilial the contents of this consi$omom ara fully and accuralal ds+eribed above by proper shipping ngme and ae e�cus:Hed,podcod,
<br /> IIIQJJJ marked,and labeled,and are in all respacte in proper condition rot transport by highway according to applicable inlarnetirnd and nation government regulations,
<br /> ISI
<br /> am a la=fl pennrolor,I Wiry Thal I have a program in plow to reduce the volume and lexiciry of waste generated to the degree I have determined to be eeonanicallr
<br /> N procltca6le end t1saA I have selected the practicable method of treatment,sloraga,or disposal currently wailo6lo to me which minimizes the press I and future IFroat to htaean health
<br /> and the onvironmeni;OR,iF I am a small quantity eanoramr•I Imus mach a good faith effort to miglmise my waste go otion and select the bast waste management method that is
<br /> a amiletble to me and they I can afford. ^` " 7
<br /> O -
<br /> r Prinred/Typedamo iR Y71
<br /> NER L. Aafl'�4 10 Signohxe f,a �' ' �� 1. i w � ;713
<br /> u f
<br /> w Y 17. Transporter 4-AcIowladflqm6ielofmcterl f
<br /> WA Prinled/Typod o 1 , Si nature t/ th� Da ye
<br /> Oo 1 B. Trane r1w 2 Acknowled rnent of Revel I of Materials month Day Year
<br /> iPrinled/Typed Name Signature
<br /> W E
<br /> Q R
<br /> I> 19. Dlicroponcy Indicallon Spoce
<br /> Z F
<br /> A
<br /> _ C
<br /> I
<br /> L
<br /> I 20. tilt Owner er O eroror Cerfifitotl acai r o{hazardous marorlals covered b Ihie manifest ezee I 09 aI ! �,{Y�
<br /> Print /T Not)1e �/
<br /> Signature�, �•• ', bra,,,,`—..^- ,.;aa 'lay
<br /> d-r7
<br /> DO NOT WR1TF BELOW THIS LINE.
<br /> 9L?i�15
<br /> DISC 0022A 11/991 Green: TRANSPORTS RETAINS
<br /> EPA 8700-22
<br />
|