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1 <br /> Stole of Cc,,orn,o--E—ronmensal Pr�ecvon Agency <br /> arm Apps to OMB No 2050-007911Eaplres 9 30 991 See Instructions on back o t5 D <br /> page eportm Sacra Toad Suosrorn a n <br /> :on <br /> Pleat, pr ni or -ape Form designed for use on*life(12 path)ypa--,ter Sacramento Cal,iorn e <br /> 1 Generator s US EPA 10 No Mo,nlesl Document No 2 Po9e 1 inlormono,n the shaded ureas <br /> UNIFORM HAZARDOUS 2 -•� a it not required by Federal low <br /> WASTE MANIFEST gj �� <br /> �.. , <br /> i <br /> J Gerercicr,Name and Morhng Address �,,U yr ;r T s� 0 r 4-Y-1-f [ t v s � 60- <br /> 0 0- <br /> n rof r rtrrL��4�, C �� <br /> u1, a Gee a s Phan, (�J� 1crZ'[i ��j/ <br /> I 9 Tronsponer I Company Name G US EPA!D Number e e <br /> sr <br /> $ US EPA ID Number sendt1r;'x+�'r v� <br /> Tronsponer 2 Company Name y :�-trP •[ <br /> 10 US EPA ID Number <br /> 9 Desagnoted Fgulrr N me pad Sde Address <br /> r ,� I ,- <br /> �1 t I.�r,� I P.ti I ' � <br /> i at�a <br /> I t r i <br /> W, 12 Contalners 17 Total 14 Una '6 'rr r a 3, <br /> ..S DC7T Des[nphon bne hed,ng Proper Shrppmg Name liazord Class and IQ Number) No Type OvaMay WI/dol '� �Nu�sf t ' <br /> In 'AkftrNt Vdrt`•fl� f W"I11i') <br /> rt 1 v N.'ff r1 as �iria"-}'A <br /> M Y h+aay kti x"C' <br /> 31 G <br /> II !y <br /> I ' <br /> cQ„I R I T.`4 <br /> m 0 r <br /> ti -Y tc„r r '~t <br /> I I � : YrF <br /> Rry� <br /> w i t c yt, ra,r d <br /> 13. <br /> J Addttontp)?p Cs u Ty i1 K <br /> of ;r ► .s Fx,r� <br /> ✓s sy . '=T�,��T?' 4,tU'i7 <br /> Z' U <br /> O I 5 Speaol Mandl ng Instructronf and AddiI,onal InformationI 1 G y,e y �J o V` C.' <br /> Z I , r' If 1(lc;_r,ss r-rent'.' t-' S ( t <br /> A + (-� t roc Y 1 F� Jf� S 7`�, r.rr .-�v r � <br /> J gaccurately p <br /> Q 1 6 moGENERATOR aSob CERTIFICATION I <br /> m of errespecucmra that proper1 condition for Irtonsporl by highway according toapplicablernlernalionoiyond riot ono government regulationsing name and are hrd Pooled <br /> V <br /> i i i on,o large quonmrr generator I certify that I have o program in place to reduce the volume and toxicity of waste grneroted to the degree I haae determined Futurethreat <br /> to behumanhealth economically <br /> a I prou,coble and that i hove selocled she procttcoble method of Ireotment storage or dnpasot currently available to me which mrmmrtel the present and futon Ihrear to human that <br /> end the environment O0. f 1 o small quantity generator 1 have made a good foal,effort to minimize my waste generation and select the best waste monogamenl method Iha is <br /> �g�! d i. <br /> C, I o�o,lo �o m opd�t asl c r-LIOfT � 0 ntionTh )of—) r`fo r <br /> ,.d/Typed Nome <br /> r r� <br /> ` F <br /> '7 Tr wooer I Acknowtedoem nt of Receipt of Moter,als Ma Da�1 � <br /> R - signature <br /> nr* 1Tyoed ame <br /> pI? Transaon er 2 Acknowledgement of Receipt of Materials Manlh Day Year <br /> Q R <br /> Pr n. T ed Name Signature j <br /> I eo/ YP I <br /> s- <br /> C' A � <br /> U 9 D sc,tpcmy Ind-col-on SPoce <br /> F <br /> ZI A <br /> • <br /> C. <br /> LI I �� 0 1 r O..ner or 0 eraror Cernhcor,on of receipt of hamrdous matenols eovsrad b this manifest Baca I os noted m hem Month Oay Year <br /> Signorure <br /> j <br /> I rreo/Typed Name { <br /> Y <br /> DO NOT WRITE BELOW THIS LINE <br /> Yello`+ GENERATOR RETAINS <br /> 1991 <br />