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---- - -- ------ <br /> State of Cal ifornia—Envirdnmental Protection Agency jgg nStructlons on back of page 6. Department of Toxic Substances Control <br /> Form Approved OMB No.2050-0039(Expires 9-30-99( Sacramento,California <br /> Please print ort p tYewnter.e. Form designed for use on elite(12 itch) p 2 e 1 Information in the shaded areas <br /> 1. Generator's US EPA ID No. Manifest Document No. Nie is not required by Federal law. <br /> UNIFORM HAZARDOUS of <br /> WASTE MANIFEST C1 AlP0 !� 7 1 6121215 <br /> Ik S t§eusent tattitt A T s:' ml..' <br /> 3. Generator's Name aTpnd Mailing Address , TIS 1 > <br /> ,RCTA SALVA.GE � � � <br /> ` k <br /> 0 2 °x_`s E. tJT'ER A�ITI,Nt1Ts SC`aGS;:C�?lV P C 95205 <br /> f} t2if# ianei dtAt k 1D "' <br /> t <br /> in A. Generator's Phone 2 A991 463-9966 <br /> S. Transporter 1 Company Name 6. US EPA ID Number <br /> N ° fa(�y porter11 f s ' <br /> ti s <br /> xM <br /> o RAMOS E��'�ITT�C3I�NfENTAL SERIiICES C AlI� E��St�te <br /> OP 7. Transporter 2 Company Nome 8. U$EPA ID Number a q2A T $ z C r <br /> ( F�l dal fly ` , <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number x�' � �# � a p <br /> RAT 0S E,N4IIT;ORIETAL� ST rT:�I TC ISS . <br /> f3 Pbtt{t rSYbdns <br /> 151 5 SOUTH RIVER ROAD, ��ST S�IGRAAiENTID9 CA 95691 <br /> Al01414101013 5 5 6 � <br /> 12. Containers 13. Total 14 m <br /> U <br /> Jt 's ta ;t r <br /> COK 11, US DOT Description(including Proper Shipping Name,Hazard Class,and ID Numbed No. Type Quantity Wt/Vol �aste N ®r <br /> V <br /> a. CN—RCRt� TTTAIART)CTT?Sov ',;CASTE LIQTiTT3 a a <br /> (C�TLY TATER) 1� NAF,TtC96# 171 f� E <br /> G <br /> C�i E b. c <br /> o N <br /> co <br /> 00 <br /> v R <br /> N <br /> v A C <br /> 6 7. SPA her x <br /> 00 <br /> O <br /> R <br /> Cie <br /> y <br /> LU s s " k yidfib 't atlas fnr*i�oste3 teA �1 <br /> V) f',A I anal Uesc#pfa©ns for�JitSterias'Este �bo77 <br /> O �- x J11, <br /> � u � s to <br /> Z 15. Special=Handling Instructions and Additional Information <br /> a TIANDLERS M 40 HOUR oSET_A/SARA 'T'T?AINED <br /> Z W <br /> AND USE NTOSH APPROVED RPE. <br /> A z (916) 3715747 <br /> 1 <br /> t- � <br /> gaccurately p <br /> Q 16 marked,and S CERTFICATIOand re in all respects ebydcla prohper cond'rtiontFor thansport by highway according toappli able internationaly and national Bove nment regulating name and are ions. <br /> fied,packed, <br /> V <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 /> a practicable and that lave 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,it 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 /> O Month Day Year <br /> 0 Printed/Typed Name Signature <br /> V <br /> Z . <br /> iL T 17. Trans orter 1 Acknowled emenf a Recei t of Materials Month Day Year <br /> AA' <br /> Signal <br /> lu ii Printed/Typed Name <br /> g R <br /> LU 5 / <br /> 0 18. Trans orter 2 Acknowled emenf of Recei;`f Materials Month / Day <br /> O , ear <br /> a () !1 ) f7 <br /> TR Prin6ed/Typed Nam Sgat g / <br /> LU E <br /> R <br /> V19. Discrepancy Indica on Space <br /> Z F <br /> A <br /> — C <br /> L <br /> F 20. Facility Owner or O erator Certification of recei t of hazardous materials covered by this manifest exce t as noted in Item 19. Month Day Year <br /> j Printed/Typed Nome Signature <br /> v <br /> DO NOT WRITE BELOW THIS LINE. <br /> IAn7tiW 10 BAYS. <br />