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c, <br /> CPJM 0 137157 <br /> State ;4. Generator's <br /> —Environmental Protection Agency �Y <br /> Form - B No.2050-0039 IBxpires'9-30-99) f, '306 Instructions on back o �K�� xg 'Deportment of Toxic Substances Control <br /> Plga p . form Clew,�Q�for so on elite 112-pitch) iter. t <br /> g y„ Sacramento,California <br /> �? 1. Generator's US EPA ID No Manifest Document No. 4 2 Pag riformation in the shaded areas <br /> NIFORM"HAZARDOUS �. �?' vnot required by Federal low. <br /> 1lVASTE MANIFEST i +� Q S ',8 12 <br /> °f <br /> erator`",,Nam and bilin Address <br /> whim.pa <br /> S , * <br /> WDIr CA 96240 <br /> Phone (209 ) 33: 3—MO 21MUM= cmmm: 9M i3 <br /> CV 5. Transporter 1 Company Name 6. US EPA ID Number <br /> C? VM Tom=.14`R <br /> S CADO1O92SS76 <br /> 00 7. ransp iter 2 Cinpany Name 8. US EPA ID Number <br /> �yyQ <br /> 9. Desi noted Facility Name and Site Address 10. US EPA ID Number <br /> SrST <br /> DZ a� III <br /> IX 13 1 D 19 1 ID 10 161313121519 <br /> T� <br /> NN <br /> a 11 US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> 4u <br /> No. Type Quantity pt/Vo <br /> _ n <br /> w ! PG , 04 , (MM dQ n003DVJJ <br /> to (3G l <br /> DN � � t <br /> ... E - <br /> C14 <br /> FWAU732mat!—P! <br /> O N � '283, 11, t 100)r (XPA P003 DOOI', <br /> as E 127) <br /> N _ R I U IMJ <br /> C7 A C. , <br /> o T <br /> 000 O <br /> R <br /> w d.' <br /> Z <br /> V <br /> - i <br /> LL <br /> o. <br /> J <br /> Q <br /> Z <br /> Q15. Special Handlin Instructions and Additional Information <br /> if ecum MUST IVEM71 VAN UTERS 6 <br /> QROGERS AS SHUM. <br /> �t <br /> U.i 11A. MOM,, 1233. 0733- <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations.- <br /> If 1 am a large quantify generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> CL practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> N and the environment;OR,if I am a small quantity generator,I have made a good faith.efrgrt to minimize my waste generation and select the best waste management method that is <br /> ae available to me and that I con afford. <br /> O <br /> r <br /> PrintecMd N <br /> �g,a •. fir: ,rw ,` Signatur a } z Month, Day�g Year,- <br /> Z <br /> to TR 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> LU A Printed,/Typed t4ame -I, Signature r Month Day r ..-Year-. <br /> U- 0 Tdra[ns)orter 2 Acknowled emenfof Receipt of Materials <br /> O T Pri e Tyd N nglfirp 7 70S <br /> gay, ,rarf <br /> Uj <br /> N R.. <br /> V 19. Discrepancy nutation Space ' <br /> Z F <br /> _A <br /> L <br /> 20. till Owner or orator Certification of receipt of hazardous materials covere b this manifest ex t as noted in Item 19. <br /> 21 <br /> Pri to Typed Nam f Signatur Mpaf �) <br /> k�", <br /> DO NOT WRITE BELOW THIS LINE. 1 <br /> DTSC 8022A(1/99) White: TSDF RETAINS <br /> EPA 8700-22 <br />