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Y yam® 9M� <br /> wale Of and welter.Agency 141 see ltls:r'lO-.i*ms or, ux ;t �jS'0 a 17e0srtm+nl of Ft+a11h Somicaa <br /> Form Approved OMS No,2060-1039(Exprrea 0,30.9 1) va i Toxic Sudsrance,Cooi�ol t�w,a,or <br /> Afla 1roftt 7t P7rj8 7 6aarernenlO,Caltlarna <br /> Plea 14 prlraot type. ffiarm daargnaq IW yse on elft•(12-pitch ryp•wrtr•r). <br /> UNIFORM HAZARDOUS t. Qenera'Of's"EPA 10 Na. Mandell x, Iaage t Ir,ro111"auon in the shsdrd.tent <br /> WASTE MANIFEST '"� I 1 Do`uAtant I <br /> sit is nA1 required oy Federal4w <br /> S, tlenH114r's Name and Moiling Addrala A C— 9 A. $tela Manrles9e� �t�A <br /> o o CA-A 004yW Z,6'0 SQ a, slats i3ane}�triarllor's to ^e,7 <br /> i, GtAentbf'a Phone t ) ) <br /> NM t,3 CA- <br /> S. Tranap er t Company Name, 6. US EISA IC Nw111fer C. State Trees ef's ID 20 <br /> lw r + <br /> ca se Al t1 t c e . ' 1 1 1171 <br /> O. Tranapgrttr'1 Phone, e,0 <br /> 7. Transporter 2 Comp ny Name S, U9 EPA 1p Nvmper 8. Sta»Transportet'1 to <br /> t Tranaptl+ter'a PAQne <br /> :. 2. DoeVriated Pactlity Noma and She Adggr•sa IC. US LPA tO Numbw 0. Stals Rayi1hy's ID y <br /> N. raaluly's Phan• <br /> e,2. Containers 13. Tolai is, I <br /> l 11. US OOT t7taariptlon(lActudhr0 Proper Shipping Nam•,Hazard Class,and to Nurhbtr) ( OWn1dy UA+t Weals No. <br /> � No. I TYp+ Wtrvol <br /> `' CRLTFO4K:rA "I� ONLY stale <br /> ? ; <br /> QPA/L}thar <br /> E b. State <br /> R <br /> A <br /> T EPA>'Athar <br /> 0 <br /> R a. teepee <br /> Ern/ leer <br /> y d. pieta <br /> r- <br /> x <br /> J <br /> EPArCAhar <br /> W <br /> n J. Additionel Dowthptkma foe Matwisie Listed Above K. Handling Codas tot Wastes Listed Abora <br /> T>Idjc-c a, ©lA b <br /> x IN Wt?—A. IM 7-0 G. d. <br /> 9 ` !wyA IS.1`7// ,1re, 'moi <br /> ,7�(' 4.. rD <br /> It. Specie)Handling Inalruations tend Addltlona)Information <br /> € <br /> � � t•;ff l'��i l�� � <br /> 4EN1!RATOR'S CE]IMPICAT14N: I hereby deehra that th+COntMM$of this Consignment ore fully and accurately described above by proper shipping M1t,nt <br /> J and are Claautled,paokad,marked,and labetad,and art ifl all rRtpeata in proper Condirten for transport by highway according to applicable jownstionsl and <br /> notional government regulations. <br /> 111 am a large Quantify generator,r certify that I have a program In piece to reduce the volume and tosiolty of wool*ganarated to the dagrso I have dotanrined <br /> to be economic,lly practicable end that I have selected this pfsCtleabl+method of treatment, storage,of dlsposel Currently available to me.,ninh MiMIMiiaa th* I <br /> ptatenl end future threat 10 human health and the environment:OR, It I am e,&mall quannty 0t66r4t0f,I hove masa■good 11ith effort to mm'r7iiYt my*A%te <br /> generation and select the beat waste management Method that In available to me and that I con.!ford, <br /> jr -Typed Nam• �/ Sign ter isrfonth ger Year <br /> WFee 4 <br /> W T 17. Transporter i ACknowiedgem•nl of Receipt of Materials <br /> i <br /> A PrintedjTyped Name Sin Month COY Yaa/r� { <br /> 9 rtr_ I V + <br /> P 16. rens Rsf 2 Aoknowiedg•m•nl o1 Receipt of Materials <br /> p Print+ArTvOad Nance ignafwe Month Car ria! <br /> L <br /> Z <br /> 19. Oilore0snay ladlcalion Space, <br /> r <br /> A <br /> C <br /> I <br /> L <br />