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I <br /> State of CalifomiorEnvironmemal Protection ljgency <br /> Form Approved OMB too.2050-0039(Expires 9-30-4) � See Instructions on'baek of p 6. Deportment of Toxic Substances Control <br /> Please print or type. Form designed for vse on efito(12pilch)typev....'r. Sacramento,California <br /> UNIFORM HAZARDOUS I. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> J is not required by Federal law. <br /> WASTE MANIFEST A jj ;j J } 5 t} " of 1 <br /> 3. Generator's Name and Mailing Address r y t •`� y <br /> SANBORN i:i�EVROLET 1-10 E. CHEROKEE LN <br /> t a4 0.,'Stade Gerwrtdor,f0 f o 3n' <br /> LuDI, CA ;35?40-5,-D -1 <br /> N4. Generator's Phone i`}U) "34—00 <br /> 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporters ID, ! <br /> v°rA c. 0 (: Q ? t } D• �ran:port qr`t 4ttala` �@5}' 322 08 <br /> ` <br /> J h,. <br /> J 7. Transporter 2 Company Name 8. US EPA ID Number E;;$tah Tronspor*e <br /> ` F. Transporter, Phone <br /> Q <br /> Z 9. I{e�ignated FG4ili1Y�g�fid. gd�fres 10. US EPA ID Number G. State Facility's ID <br /> 103 1 <br /> C+ 66tH 4L PJAV I"A^JAG f�FAJT INS. fQs 7l <br /> 1.7104 W. FIRS STREET H. Fociliy',Phos» <br /> �r1c , i ten' rt v J i 2 ! i� <br /> U u x(818) X334-511' " <br /> n^ a A� �F.. E � � <br />.I✓ 12. Containers 13. Total 14. Unit <br /> Z 11. US DOT Description(including Proper pping Name,Hazard Class,and ID Number) No Type Quantity Wt/Vol 1. Waste Number <br /> kQ WASTE PAINT RE LA U MATERIAL ,Cafe 214 . <br /> 3 G i t roJ J. I I l EC10 i ) EPA/Other. <br /> 17-11 F0050 E b. Stats <br /> co <br /> N <br /> E EPA/Other <br /> v R <br /> A <br /> T c State / <br /> O <br /> EPA/Other <br /> o: R <br /> IW-. d State <br /> Z <br /> CJ A/Other <br /> LU <br /> Z �L Ad <br /> o A)L 10 O DD1402E AT�•SO 1<' y� FOQ F{ 3� b . <br /> J. <br /> N It <br /> Uj <br /> Z' <br /> Q 15. Special Handling Instructions and Add I Information / <br /> P: EMERGENCY PHONE 588 �5 :38? <br /> Z <br /> W <br /> 16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of this Consignment are fully and accurately described above by proper shipping name and are classified, <br /> Q pocked,marked,and labeled,and are in,all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> U <br /> If I 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 <br /> J <br /> � economically practicable and that I havoselected the practicable method of treatment,!!qrag&jdor disposal Currently available to me which minimizes the present and future <br /> to threat to human health and the envirorwn�srnt; OR, if I am a small quantity general ah / <br /> ve ;rode a good faith a rt to min' ize my waste generation and select the best <br /> waste management method that is available to me and that I can afford. _ <br /> O /Typed Nome ) SignaWre r Month Day �e <br /> Y\. <br /> Z T 17. Transporter 1 Acknowled emen of Receipt of Materials I <br /> Lu R Month Da Year <br /> A Pripfe Typed Name Signature r <br /> P <br /> LU 0 18. Trans orter 2 Acknowled ement of Receiptof Materials <br /> LL- <br /> T Printed/Typed Nome Signature Month Day Year <br /> O E <br /> It <br /> N19. Discrepancy Indication Space <br /> U F <br /> U A <br /> Z C <br /> I <br /> 20. rnl <br /> Facility Owner or Operator Certification of receipt of hazardous materials covered b this manifest exce f as noted in Item 19. <br /> T Printed/Ty d Nae I Signature Mornih Day Year <br /> P,�I—i L-L� 0 13 <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> (Generators who submit hazardous waste for transport out-of-state, <br /> DTSC 8022A (1/95) produce completed copy of this copy and send to DTSC within 30 days.) <br /> EPA 8700-22 <br />