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Teris <br />FORM #FS-UHWM <br />(EXPIRATION DATE 9-30-98) <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 />1 0 6 0 3 0 4 1. 211 9 9 <br />n : <br />areas is not required by Federal <br />(Continuation Sheet) <br />c A A 1 1 <br />- Zak <br />law. <br />23. Generator's Name '• - "' =" <br />L. State Manifest Document Number <br />",-MlACF IAIRPPTL1. tfill) m_. i'.AM"row <br />C3�223g03(y$ - <br />p 12:1 WVI CEI FOM Wo(lrl OPI. CA 9':4111 <br />M. State Generator's ID <br />mWTCA, CA A?'rx: xuaac+.'+. AkMPBW'4 <br />(209)982-5 ')0 (2091.66-9066 <br />24. Transporter Company Name 25. US EPA ID Number <br />N. State Transporter's ID <br />O. Transporter's Phone <br />26. Transporter Company Name 27. US EPA ID Number <br />P. State Transporter's ID <br />Q. Transporter's Phone <br />29. Containers <br />30. <br />31. <br />R. <br />28. US DOT Description (Including Proper Shipping Name, Hazard Class, and ID Number) <br />Total <br />Unit <br />Waste No. <br />- <br />No. Type <br />QuantityWWol <br />a. <br />rg: '.26) tpit 74452 a) _ _ _. <br />{: 5 T <br />51.2 <br />X <br />19 <br />rx <br />' <br />b' <br />. <br />2S) SF`: CGi 41413) -.-_..._. , _ -.. ,- <br />517. <br />P <br />B <br />2114' <br />C. <br />140) <br />�IeO-. . <br />. 1pEe'T4449:)) .. ... -. -. .. _ _.. _ -_ <br />- - <br />D P <br />p <br />tTA <br />d. <br />N <br />P <br />r <br />erA <br />E <br />A <br />a. <br />14$ . tpE: 649402) <br />T <br />0 <br />R <br />51). 1T+t`+ 144523) <br />tin <br />s <br />K12 <br />h, <br />seve rlgl+Ta. ACTo1.-. ?Tamcsstsc0. s o..s. irrx: z.,: eo <br />— <br />uA <br />n� <br />D P <br />A <br />4 d <br />`Descriptions <br />S Additional for Materials Listed Above <br />T. Handlih es for Wastes Listed Above <br />1 1RA: 74452me 22Hi VRNr 1* 2802 ^444:11 we 2802 699402 24X4 <br />009402 x• ?9P. 70,4523 0. 380: 7445a? •* 299: "610s4 <br />32. Special Handling Instructions and Additional Information <br />T = nppcaFcl wtre I wk., W- w:xi.vr�-� .aar 4+6 .-CV2 ;a'a.;0= :sY>• ..-;,-. c.r <br />.' vt19T WMA YV9Ipl ph2 41) CIM <br />?51.4(4,) 11)hNQi.1JY40[L- S:R1wYA Fid �.6�]�'91 bfl.Y }.?,{q ^.�j tC " �M 1.19. 11b TOt} 1411-0 r13kV'4 <br />C�rpi� <br />T <br />33. Transporter Acknowledgement of Receipt of Materials <br />Date <br />R <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />N <br />S <br />P <br />a°34. <br />Transporter Acknowledgement of Receipt of Materials <br />Date <br />E <br />PrintedlTyped Name <br />Signature <br />Month Day Year <br />N <br />35. Discrepancy Indication Space <br />A <br />c <br />I <br />T <br />Y <br />