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07/06/2006 14:34 1 SANBORNCHEVROLETINC PAGE 05/05
<br /> Siete of ColiFamio—Environmanial Prolection Agency
<br /> Form Approved OMB Na,2050-0039(Expires 9^30.99 See lnsnkrclioltS on back of page 5. Dep.rfinenl of Toxic Substances Contra!
<br /> Pleosw print or type. Form dasrgned for use on alife(I ^titch)typawrrldr. 5ocromonl0,California
<br /> 1. Genealar's US EPA ID No, Manifest Document No, 7„ Paga 1 Information in the shod sd areae
<br /> UNIFORM HAZARDOUS � ,: / is not required by Fadaral law,
<br /> WASTE MANIFEST d°'a r�I' r ' Gd of Y
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<br /> �, Generator's Name and Mailing AddraL,;+ � �y r � R'' � a^Ila+(fJBCUhI96C+'Qum61
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<br /> c5. Transporter 1 Company Nome 6. 195 EPA ID Number f 5f1bTa Transporter'!.Ib:IRsbn :1
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<br /> 7. Trans rtwr 7 Company Nane 9 US SPA ID Numhar
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<br /> v 9. Design.!rd Facility Name and Sitw Addrc is 10. US EPA ID Number . 'sihia Fd�6 fry s(�
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<br /> 12 Ql2 'Containers 13. Total 14. Und
<br /> U 11. US DOT Dwscripiion(mduding Proper 5�,ppirrq Nam.,Haterd Class,and ID Number) No T e Quantly Wt/Vol I W.cypi Wbm60r
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<br /> O15. Special Handling Inmruclions
<br /> ••s� and AddFN nal Information I
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<br /> mi 16. 6RNhRATM CERTIFICATION: I herob declare that the conienrs of this consignmant are fully and accurate)�described above by proper shipring name and are clomiRad,poelted,
<br /> Umarked,and labeled,and ora in all ras chs in proper condition ter transport by fiighwey aocording to applicable intarnotionel and national gavommnnl regulations.
<br /> 2i IF I am a large quantity gen.retor,I cm'fy 1hnF I have d program in place to mcluee the volume and loxlc;ly of waste gonarated.to the degree I ha"derarminad to be eeorromleall
<br /> a pmcticabla and that I hwa selected fha racticable method of treatment,storage,or disposal cv renlly ovoilUlale?a-me vlhfgh mlhimlzas tha.pm!go f dnd'.{U1ure Ihraat'10 human health
<br /> N and the envlronmenh OR,if I am a sma I quantity generator, I have moda a good faith efforrto minimize my wade Benaratiom and snlact the best waste management method that is
<br /> Ce available to me and that I can afford.
<br /> O} Priniad/Typed Name `I � Signature /r ..•.,P'•'- Month Day Yaar
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<br /> 17. Transportar I AcilmawWatiment of Raw t of Matorials
<br /> OG N Pr'rnt.d/Typal Nama '� :R r Signature fv !' •� J Month F Day Yenr �.
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<br /> U. 0 18. Trans rt Aaknowlad wmant AR4,cm,)t'of M erlols
<br /> 1 Priniod/lyp9iirNamis SI notate Month Day Yaar
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<br /> U 19, Discrepancylndicotlon Space
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<br /> 1 20. Focflily Owner or O erefor Certification i6f receipt of 1—isr-clans materials cevernd by this manifest axcapt as noted in Itam 19. _
<br /> T Printed/Typed NowSignature Month I Dlay Yalar
<br /> DO NOT WRITE BELOW THIS LINE.
<br /> DTSC 0 (1/991
<br /> F,PA 8700-22 Yellbvr: GENERATOR REUIN3
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