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Stole of Cali forniE)-Environmental Protection Agency
<br />Form, F*.vld OMB No. 2050-0039(Expires 9.30-99) See Instructions on back of pane 6.�, Depom
<br />dent of Toxic 5a6s1anees Contral,
<br />sco , pr•nl or lype. Form designed for use oa elite (72pikh) ly 'er. Sacromenlo, California
<br />UNIFORM HAZARDOUS
<br />orator's US EPA ID No. Manifest Document No.
<br />2. Page 1
<br />Information in the shaded areas
<br />11;,
<br />is net required by Federal law.
<br />WASTE MANIFEST
<br />of
<br />3. Generator's Name and Mailing Address z'
<br />51 a Manifest Do moot Number
<br />T� eTsU`Is LAM# � '�"
<br />G ID.
<br />3
<br />� V
<br />ROAD 5'Pat:dLlsati, (.tA. 95201
<br />8. State Generator's ID
<br />G ATPN:
<br />4. Genorara':s Phi2d9i9e11-5776 f?ATIsZ,�A71�7AdgalUMS
<br />e 5. Transporter 7 Company Name 6. US EPA ID Number
<br />I
<br />C. State Transporter s ID [Reserved.)
<br />Tronsporter's Phone
<br />1iA.i8 L=D.
<br />7. Transporter 2 Company Name 8. US EPA ID Number
<br />E. State Transporter's ID IResenved.
<br />F. Transporter's Phone
<br />j 9. Designated Facility Name and Site Address 10. US EPA ID Number
<br />G. State Facility's ID
<br />9B.ta Joaquln prili
<br />7656 9, RA 6Rma=Yal@
<br />H. Facility's Phone
<br />j STs(.` mal CA 96208
<br />:A-litifFlin
<br />3 11. US DOT Description lindeding Proper Shipping Name, Hazard Class, and ID Number[
<br />12. Containers
<br />13. Total
<br />_
<br />ldUnit
<br />No.
<br />Type
<br />Quantity
<br />Wt/Val
<br />I. Waste Number
<br />. dMA+!itti LTOYMS. 9.O.S., 5, ry(199?. P3 II,
<br />State
<br />(]. ab-paa)r) . (ors:-;: 1281 . (P£: 74452,-)
<br />ffi3w
<br />EPA/Other
<br />C(I!
<br />P
<br />C1 ? r, I
<br />P
<br />M
<br />.. ... . , i
<br />State
<br />II. (Poa£:ng taxa. ?lllmtaasroa). tea g: 1331, (pfs j ..
<br />612
<br />(
<br />EPA/Other
<br />l
<br />P
<br />NR
<br />d3(r PE:BTICIDIRSS L.T()UTF, 1^_.Al4RHYE. TSTJCIC, 3 (5.11
<br />Stole
<br />*213621 _ M 11 (E^tr•nchtizm, ^61or•Sma} , (erg:
<br />g j2
<br />L 31.) - Ipf' '4'15d2.D
<br />1 0'
<br />PST
<br />!
<br />EPA/Other
<br />p
<br />r. U/ O
<br />if
<br />PTA
<br />g,•AITSTTC ATxAy-T LIQ7,10S. N.O.S,. 81 rd1011'I1.9. P3 TT.
<br />State
<br />flab -Pack) , (, 9W 154) , (p£: 744.251
<br />512
<br />•�
<br />saw
<br />sawEPA/Other
<br />P
<br />IAA
<br />1. Additional Des tions far Materials Listed Above
<br />" 13At 7448+' 744321 '44522
<br />K. Handling Codes far Wastes Listed Above
<br />118: s* 110: 74452fi
<br />6.
<br />I _
<br />d.
<br />1 S. Special Handling Instructions and Additional Information
<br />of ar approxi at•A PPL; etsar. :usnd:iinq ha as,leaza a sarrz-ale.Wa,rtazn Pt:LSA. esr.ampt pec 40 Opgi pry- appropriate
<br />PPE when ham]1irg haznrdays xatartal s. R'eatsse SCiM •iaempt pec 4c cm
<br />'+5i.. 4(b) (1) azn]suxon. emnsta ansa paoMm3 49 CM 111,121a. Sabi 1483- 015359
<br />"wu!er gazsa_. cont_aas't ` ,r.Tlvw R9llD (204)438-L 71" WZAnk PNRIPM n1R4SCE'C"fli'p_ EC/T}ygYl'L fPR'}Wsrs';: rLe:IDt.SN<?
<br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consig ment are fully and accurately described above by proper shipping name and ore classified, packed,
<br />marked, and labeled, and are in all respects in for transport 6y highway
<br />proper condition according to applicable international and national government regulations.
<br />If I am a largeq o ftp• generator, I certify that I hove pro gram in place to reduce the volume and toxicity f waste generated to the degree I have determined to be economically
<br />practicable and that I uv elected the pradicable methodalltreatment, storage or disposal currently available to me which minimizes the future threat to human heolth
<br />present and
<br />and the environment, OR, i111 am a small quantity generator, I have made o good faith effort laminimize my waste generationandselect the best waste management method that is
<br />--
<br />voila6le Io me and that I can afford. /
<br />Pr' Typed Nfmip /.;' t L 7
<br />Sign t (1/. i'
<br />Month Day Year
<br />l n,� X � 11-= ,' ,�. , ,
<br />_ 1Prt 7 l.' j'!1
<br />z
<br />� ) �
<br />b t
<br />17. Transpotler I Acknowledgement of Receipt of Materials
<br />P N ped No c- Sign t t Mon Day Year
<br />10 �f
<br />19_ T nsponv 2A L,.ewled v enr o(Rae i tot Materiels � -
<br />Printed/Typed Name
<br />Sign aNre �_
<br />Monfh Dr Year
<br />19. Discrepancy Indication Space
<br />i_
<br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest ii .,'notedin
<br />Printed/Typed Name
<br />Signature
<br />Month Day Year
<br />DO NOT WRITE BELOW THIS LINE.
<br />["SC BC22A (1/991 Yellow. GENERATOR RETAINS
<br />FPA -17CI-22
<br />
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