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FORM #FS-UHWM
<br />UNIFORM HAZARDOUS
<br />21. Generator's US EPA ID No. Manifest Document No.
<br />22. Page
<br />Information in the shaded
<br />WASTE MANIFEST
<br />C A R 1 I 1 0 0 0 5 0 91 2 1 6 6
<br />2 of 2.
<br />areas is not required by Federal
<br />(Continuation Sheet)
<br />law.
<br />,,
<br />23. Generator's Name
<br />L. State Manifest Document Number
<br />._ ,tea
<br />LOMAIE 7--itori1S. 1010 M. aA29LT(M
<br />CA42390872
<br />7323 L M ACE PDAs STC7(P - CA 95201
<br />M. State Generators ID
<br />MANTICCA, CA A3"ERTe E1183RA AWtriY V4
<br />24.Transporter ompany Name iaoo�25. US EPA ID Number
<br />N. State Transporters: ID
<br />O. Transporters Phone
<br />26. Transporter Company Name 27. US EPA ID Number
<br />P. State Transporters ID
<br />Q. Transporters Phone
<br />29. Containers
<br />30.
<br />31.
<br />R.
<br />26. US DOT Description (including Proper Shipping Name, Hazard Class, and 10 Number)
<br />Total
<br />Unit
<br />Waste No.
<br />No. Type
<br />Quantity
<br />Wt(Vol
<br />a.
<br />OCKM IM CL940D%Vr. CPM -D, 0ar06o10) (T.i.Witad Qaantlty),
<br />(..cg+ 126) . (pf, 74.4528)
<br />1
<br />EST
<br />o12
<br />Gov
<br />0 r
<br />P
<br />WA
<br />b.
<br />PATNY ROTATED KNTMRIJAT.. 3, UM263. PO II, (E-11624).. (�$:
<br />1?a)• tpfa co147.91.1)
<br />C r
<br />C.
<br />M&4=ITa4 WITRATM PB TLTSERS, .6.1, WA2072, PR ITS, (at$,
<br />_ -
<br />140), (pf, 744493)
<br />&
<br />I D R
<br />f
<br />G
<br />d.
<br />OXIDIUM SOLID, W.G.S.. B. 1, IM479, PO 11, (ehlorin?
<br />J
<br />E
<br />tabl?ta, Potaaei,m nitsitn), (ex$, 140), (pie 699402)
<br />N
<br />Ea T!R
<br />E
<br />-
<br />DM
<br />C+
<br />P
<br />DAA.
<br />R
<br />A
<br />0,
<br />OXIDtBItiG LIQUID, 00NKJ5TVE, N.O.B., 6.1. 111I3090. EO TIF,
<br />T
<br />(?x:l: 140) , (PC, 990402)
<br />��1l..,� `
<br />EBT
<br />(J,_j
<br />R
<br />4N
<br />D M
<br />0
<br />=
<br />14A
<br />f.
<br />8(i PESTIC'TOES, Sol -to, T Tc, N.G.B., 6.1, masse, PO II,
<br />,
<br />(DIAYTW(M , DI9Mx(YYW ) ("*tin* pcll,stant) , (?J: 151j,
<br />(/
<br />(pf: 744523)
<br />tJ I
<br />W S T
<br />1m
<br />TPA
<br />9.
<br />.. .. _ .
<br />74463.?)
<br />B2 .S T
<br />512
<br />D T
<br />X
<br />WR
<br />h.
<br />COR00SI4'P: LIQUID, ACIDIC, LTA%1iAM0, W.G.S., 0, U93264. RO`,
<br />TT, (HYDEWrATIARIC ACID. PMSVWYFLTC ACID), (a¢$, 154). (pf:
<br />769984)
<br />vc l
<br />^
<br />D
<br />{oT�v ��
<br />p
<br />AN
<br />D P
<br />K
<br />�A
<br />S. Additional Descriptions for Materials Usted Above
<br />T. Handling Codes for Wastes Listed Above
<br />• FOA, 744520 *• 29D, VW. ++ 28C, 744493 +• LIM 69840-7 +• 2M
<br />$98402 •• 2M 744523 •* 8ara: 744532 a+ >RM 7153884 •+ 292, 744$39(
<br />) •
<br />32. Special Handling Instructions and Additional Information
<br />Waat appropriate PPE rh handling haraxdona p?s 4n C:fR x r appx.rg xar<s
<br />PPM rhea hamiiin$ hazar,*x. mat s:ala.Wast?ie WRA +ter t- par t0 CSR
<br />261. 4(b)(1) axolaaio,:, Want+ rae Paoks9 aaoarding to 49 CER 173.12h. Jcbf 1483- 06576
<br />Altaa
<br />T
<br />33. Transporter Acknowledgement of Receipt of Materials
<br />Date
<br />A
<br />Printed/Typed Name
<br />Signature
<br />Month Day Year
<br />N
<br />SP
<br />A
<br />34. Transporter Acknowledgement of Receipt of Materials
<br />Date
<br />Printed/Typed Name
<br />Signature
<br />Month Day Year
<br />E
<br />R
<br />\
<br />A
<br />35. Discrepancy Indication Space
<br />c
<br />GQ
<br />L
<br />T
<br />Y
<br />
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