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^ State of California—Environmental Protection Agency ORDER # <br /> 137A7 <br /> Form AppfovwJ OMB No.2050-0039(Expires 9.30-99) See Instructions on back of a 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12-pitchy riter. Sacramento,California <br /> . <br /> UNIFORM HAZARDOUS 1Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFESTih b Io 14 6 1# Ls 19 Io a 5 1 12 of <br /> A #ate Nian�# Document>�beX <br /> 3. Generator's Name and MoTTiling Address <br /> FAB <br /> 029 :���SACRAMPAW tggq ��qq <br /> DI AtS9 ����i1r <br /> W) <br /> d. Generator's Phone209( )333-3500 magma= • BM <br /> CV 5. Transporter 1 Company Name 6. US EPA ID Number 'G TtataTroctspordgts.D} <br /> od 3 INC O A E? 0 1110 9 2 5 �� 7 6 � Tran�partd'rs s�f,a�r�XT� <br /> 7. Transporter 2 Company Name 8. US EPA ID Number <br /> P P Y <br /> ter,.1 <br /> � � ,Trcxtisprister'sPhot9��t �' i k gat c s� � Y" � <br /> _ U 9. Designated Facility Name anAddress Nd Site Add10. US EPA ID Number G_ State Extcifrfy a TD-i y ,. <br /> E x ' <br /> INVIRC .. <br /> . Z ,}� <br /> O X 111 `H Fac ty-SS -f00Pi <br /> p OUT . < t O" r <br /> 15 19 <br /> slew;' <br /> s <br /> Q1 2. Containers 13. Total 14 Unit s` . <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> („) No. Type Quantity Wt/Vol `Vy'gsiau#te3' 's,vs <br /> 10 <br /> NO <br /> ;F <br /> Z 0R r PA TED MATERIAL <br /> t- 3� 263, 11, 100), (EPA 05 01 D035), <br /> G { 12700 <br /> 0000 E 3, ' 263, PG 11, M-100), (EPA P003 D001), <br /> 4 R (IRG 127)04 <br /> C. <br /> o TCo 0 <br /> wx� <br /> R � <br /> LU <br /> d. #� ° <br /> LUa" <br /> V -�x s <br /> dc{r oncl Descry¢tticns for Md#erto s l+atea ove K. Handling Codes for Wastes iis#et A org y <br /> w <br /> its 'est st ',K'•:?is s 1gTxrcn +�,�. <br /> mr <br /> >„nM. <br /> 0 15 Special Handling Instructions and Additional Information VOMOPM CTI' MM '9BE'N HANDLIM <br /> Q <br /> EMEWENCT C SA CBEKMW2 1-800-424-9300. CATIM MUST IMNTIFY VAN WATERS � <br /> Z ROlGERS AS SHIPPER. <br /> = 11.A. VA38533, 11B. GA10733—VA02 <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,pocked, <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 I am a large quantity 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 economiColly <br /> 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 effort to minimize my waste generation and select the best waste management method that is <br /> available to me and that I can afford. <br /> OPrinted/ ,ped Name 41 1 Signgture j ' f Month Day Year <br /> w <br /> 1 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> 'A Printed�lyped Name Signatures- Month Day Year <br /> Uj <br /> �T�: <br /> r ' <br /> P <br /> LA_ 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> 0 RT Printed/Typed Name Signature Month Day Year <br /> UJ .E <br /> N R <br /> Q <br /> lJ 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> i <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> Printed/Typed Name Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/99) Yellow; GENERATOR RETAINS <br /> EPA 8700-22 <br />