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State of California -Environmental Protection A enc <br />Form Approved OMB No. 2050-0039 (Expires 9.30.99) <br />Please print or type. Form designed for use on elite (12 -pt writer. <br />UNIFORM HAZARDOUS 1. Generator's US EPA ID No <br />WASTE MANIFEST CAL.0002562 <br />3. Generator's Name and Mailing Address —MA-1—TIN 1:11' UWE 1 <br />-1,704 FITE CT <br />W) 4. Generator's Phone (F 09) 9,46-3746 <br />N <br />See Instructions on bac ge 6. <br />Manifest Document No. 2. Page I <br />06 1 I I 12 ��} 9 I I of <br />rC N 5.yy��Transporter 1 Company Name �7' p;('. 6. US EE�P�A IeD <br />I'lO <br />OF 7. Transporter 2 Company Nome 8, US EPA ID <br />LOU <br />r -Q <br />NZ <br />ad <br />LOO <br />LL <br />0.1 <br />NU <br />Z <br />G <br />CV E <br />o N <br />eco E <br />v R <br />c A <br />o T <br />a0o O <br />R <br />Uj <br />w <br />t - <br />Z <br />w <br />U <br />u, <br />N <br />Z <br />O <br />N <br />w <br />Q <br />Z <br />O <br />E- <br />Q <br />Z <br />W <br />H <br />Q <br />U <br />9 Dg$ 9otefl F i ity a e on , ite , dress J .L t0 SCA 4 10. US EPA ID Number <br />INC <br />51.550 SAL_ I DA BLVD <br />SALIDA CA 95368 CAT000613968 <br />Department of Toxic Substances C <br />Sacramento, California <br />Information in the shaded areas <br />is not required by Federal law. <br />H. orare mamrea,r wcu carr-rvrzrunr"•w <br />B. State Generator's ID <br />I' ( r I -I- <br />C. State Transporter's ID (Reserved.]; <br />D.,:;Trohsporter'i. Phone <br />h �.n <br />E., StateTraosporter's ID [Reserved] <br />F.'Tiransporter's Phone <br />G State Focility"s' ID fa' <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) No. T p <br />a. USED CLEANING COMPOUNDS, N. 0. 1. B� N. D <br />LIQUID ( NOT LdSDUF OR USE:.r A REGULATED) <br />AQUEOUS PARK'S WASHER SOLUTION M. 3#GAL ] 11 � <br />b. <br />C. <br />d. <br />753 <br />20?, 54"-101:1 <br />13. Total 14. Unit <br />e Quantity Wt/Vol %T Waste Number -: <br />State <br />G a� <br />EPA'/Other <br />State <br />EPk/Other <br />State' <br />EPA/Other, <br />st„�a <br />EPA /Other , <br />J. Additional Descriptions for Materials Listed Above • K. Handling.,Codes for Wastes listed Above <br />b• <br />C. d• <br />,:Nciol HR Instructions and RE�ID#8004 <br />itionanff�orrmmatiA ��U345 � 1 utf C,'� f �..4V9 UU'24 /r_t,207900072; .1.301 c°24 <br />A 941 B Cr j} <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by propers hipping name and are classified, pocked, <br />marked, and labeled, and are in all respects in proper condition for transport by highway according to opplicable international and nationol government regulations. <br />If 1 am a large quanti generator, 1 certify that I have a pr ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economical) <br />J <br />J ty csg <br />CL practicable and that love selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human heals <br />Nr .r . — .r � - -- - - --_tr -_---- ------'-- r L_..- --J- - ___J C -:,L _CC .... ......:..:...:tee ...., ......,m ,.e..e...K...... A .slut she Fred rondo mnnnnamnnt mathnd that is <br />W available to me and that I can afford. <br />r >_ Printed/TypeALLL m_e � SignotureMo th Day Ye <br />Z 2 <br />(X <br />M T Transporter 1 A nowled ement of Receipt of Materials <br />R - <br />w Printed/Typed e <br />LU S ��rtic=r• <br />LU <br />u- Il 18. Transporter 2 Acknowledgem <br />R <br />T Printed/Typed Name <br />:w E <br />Ln R <br />U19. Discrepancy Indication Space <br />Z F <br />- A <br />C <br />I <br />L <br />( 1 20. Facility Owner or Operator C <br />T I Print Type Nome <br />Y <br />Signature <br />Signature. <br />DO. NOT WRITE BELOW THIS <br />19. <br />i <br />Ye <br />e.. <br />Month Day Ye <br />1 I <br />DI Q6 5 <br />