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rotection Agenc <br /> .,u-00 39.(Expires 9-30- 9) See Instructions on back of page b. Department of Taxi Subsf an es )rol <br /> arm designed for.luse on elite 12-pitch)N�-writer. Sacrament ,Calibrn <br /> UNIFORM HAZARDOUS merator's US EPA ID No. Manifest Document 2. Page 1 Information in the she e <br /> is not required by Federal law. <br /> WASTE MANIFEST of .i <br /> 3. Generator's Name and Mailing Addre A. State 1Manifest Document Number f"f1 0 9 9 6 <br /> „ , __ "f t( f :1(•`_ B. State Generator's ID <br /> LO <br /> 4. Generator's Phone <br /> 5. Transporter 1 Company NameLn 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> OP <br /> O D. Transporter's Phone <br /> [,may CP 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.) <br /> r J <br /> QF. Transporter's Phone <br /> U 9. Designated Facility Name and Site Add ss 10. US EPA ID Number G. State Facility's ID <br /> Q <br /> 1'K4C1( 11. {^:h`.,t_SL)Riri. {{G C" Vi=f`Y 1 C 2* 14 1 Q 1 e <br /> Sit O 31.50. EAS-1 PICU BLVD. H. Facility's Phone <br /> tL LOS ANGELES, ", '''`'� t^ A 17 G� 4 1 1 1., (60 ) 49-7145 <br /> Q12. Containers 13. Total 14. Unt <br /> ,. d U 11. US DOT Description(including Proper S ipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/VoiI. Waste Number <br /> �I <br /> ZState <br /> State <br /> 3 G _ EPA/Other <br /> o <br /> E N b. State <br /> c0 <br /> co E RQ. WASTE F'1GiINT RLLAi`.r_1 MATERIAL. 3, UN126-?., P'u1.i <br /> V R (1 C%t(%},�,) 6 7 / j•1 r t 7 `t .:' EPA/Other <br /> C14 A /' r ✓ <br /> O T C. State <br /> -... r r, a w n EPA/Other <br /> R _ _ .. . <br /> wd. Stale - <br /> Z <br /> III <br /> U EPA/Other <br /> LU <br /> N J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> O a. b. <br /> V)Uj — <br /> cry rrr r r 111 1 40, F. "[ } t ? G '' f 4 <br /> J �J <br /> Z r _ <br /> O 15. Special Handling Instructions and A4flitio al Information <br /> Q11.t? i A P# 9 4.4 r *4 <br /> s, u� <br /> Z +VL.So 60EtGLLS PF,i ;Lc 1iE CtDtHTNd <br /> LU A <br /> _ <br /> 16. GENERATOR'S CERTIF16ATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> Vmarked,and labeled,and are in all resp cis in proper condition for transport by highway according to applicable international and national government regulations. <br /> If I am a large quantiy generator,I cern 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 /> practicable and that I have selected the acticable method of treatment,storage,or disposal currently available to me which minimizes the present and Future threat to human health <br /> and the environment;OR,if <br /> 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 /> O <br /> available to me and that I can afford. <br /> Printed/Typed Name 1knature Month Pay Year/ <br /> U <br /> w T 17. Transporter 1 Acknowledgement of Receiptof Materials i } <br /> UJI <br /> O p Prin yped Name _ SiBngtu Month Ba ) Yea(/� <br /> U- 0 18. Transporter 2 Acknowledgement of Receip of Materials <br /> O T Printed/Typed Name Signature Month Day Year <br /> w E <br /> N R <br /> U19. Discrepancy Indication Space <br /> F <br /> Z <br /> — A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of recei t of hazardous materials covered by his manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 0 (1/99) <br /> EPA 87700-0-22 Yellow: GENERATOR RETAINS <br />