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., • --- alifornio�nvironmemol Protection A <br />Pproved OMB No. 2050-0039 <br />print or Type, Form des; (Expires 3496) <br />geed for use oil elite12. See InitruCtions on baCK of <br />f _.,� tinewr;rer. page 6. <br />UNIFORM I Generator's US EPA ID No Department of Toxic Substances <br />WASTE HAZARDOUS Manifest Document Sacramento. California <br />MANIFES N 2. Page I Information in the shaded areas <br />O 1 3. Generator's Nome and Mailing f) t✓ L' C' �' �' 7 (0 / / t ) /„ 7 C� of / is not required by Federal law. <br />h Ad <br />P j1 y 5 r c 1 v to r,f, . �,.�, n /�. e % • i3� X S c i �� _ A. State Marufed DocvmeM <br />Number <br />C14HAI' <br />958476E <br />C? .. Generators Phone (� S v LCrsr <br />�1L1, y 7 E ,�.-lr�;f �' e. State <br />p ,a/ Gaserator's 10 <br />0 5. Transporter 1 Company Name / i/s 7 7 -'Y&/ e, <br />6. US EPA ID Number C. 14 ry <br />00! <br />If " <br />state Transporter:.. <br />,frit 5 <br />Q=Com anY Name7. Transporter 2 'i.D.-TronsQarter•s <br />phone +� <br />U 8. US EPA ID Number CKQI, 3 y 7 <br />State Transporters ID <br />y7 Z 9. Designated Facility Name and Site Address <br />Cly e s(irl 4.v-5 m N 10. US EPA ID Number F. Tran rter's Phone <br />o t k y le M e-;"? <br />3 _5- .2 s l O L. U S k 4 r e ' l 1, (, y 7 G. stat, Focirty's ID <br />y Qo tic{ l , � SOX / <br />U relfkhA.v c, 1<1 f <br />3 " Focfliy's Phone <br />11. US DoT Description T U CI tl (/ j j 7 <br />-j ` = Pion (including Pro •r Shipping • �07 ,�Q / — /•' 7r,(/ <br />PP 9 Plante, Hazard Class, and ID Number) 12 Containers (n T <br />3� F- ° 13. Total 11. Unit <br />3 p/ -l4 Z k' r�V V J 4V'4 .5 to n No. T Quant' <br />ni G 11 /114 3E A- .� , L r Ca ✓ r r�2 r rl r s r fY Wt/Vol I. Waste Wrriber <br />0 E `� l State <br />N b <br />0 I E L� (fI Lf U y C f7 EPA/0tjVrO <br />oI A I Stalle <br />0I T — <br />Q EPA/Other <br />0: R <br />w <br />It - <br />State <br />Z d. <br />U I I EPA/Otfser <br />N state <br />CL J. Addttianal <br />Z/eDescrirp/;� ; forMae�rialsSAibdov <br />EPA/ <br />GjL/V K. Handling Other <br />Codes for Wosies Listed Above <br />Z <br />i Pr 0 979 b <br />0 <br />c <br />1 5. Special Handling Instructions and Additional Information d <br />ZVy :Lips ilecLU �/4/' <br />_ mery <br />Sr 3s3-�s�r7 <br />16. GENERATOR'$ CER- F16 I her by declare that the contents of this Consignment <br />Q pocked, marked, and labeled, and are i all res <br />U respects in proper are fully and occvrately described above b _ <br />J P per condition for transport by hiphwoy accords to a Y proper 'hipping <br />'s9 PPIKable international and r,cztionalgp government gvlcrtand Ore ironsdI <br />.� If 1 am a large quantity generator, I certify 9 quant) <br />CL economically Practicable and that I ho Mat I have a program in place to reduce the volume and toxicity of waste <br />N threat to human health and the enviro selected the Practicable method of treatment <br />O waste mono ement method that is availo letto R, and that I can afford. storage, or di generated to the degree I hove determined to be <br />CNt, if I am a small quantity generator, disposal currently available to me which minimizes the present and future <br />Printed/T hose a flood foA effor. to <br />YP Na <br />> ^ minimise my waste generation anselect <br />Sig <br />— d the best <br />Z T 17. Tions iter 1 Acknowled ement of Recei t of Materials Month <br />1J r �DaY Yeo <br />7 A Printed/Typed Name / <br />if � N <br />$ <br />Signature <br />r <br />0 18. Trans er 2 Acknowled ement of R Mores Day Yea <br />1I ER Printed T °Cpl of Materials <br />/ Yped Name <br />II R Signature <br />19. Discreporscy Indication Space Ma^fh Day Yeas <br />F <br />A <br />C <br />1 <br />L <br />1 20. Fd/T owner or rotor Certification of aces t of hazardous materials covered b this manifest exce t as noted in Item 19. <br />T Printed/Typed Name <br />r <br />signotvre <br />Month Day Year <br />DO NOT WRITE BELOW THIS LINE. <br />8022A (1/95) <br />6700--22 Whitr 'SDI SENDS THISr t <br />TO P_O dog 3000 Socrarn, rG J S1_ WITHIN 30 DAYS <br />nt�. CA 75812 <br />