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10/26/,00 12:24 209 953 4762 <br />=arm Approved OMB Na.'2050-0039 (Expires 9.30 991 <br />,lease print or We. Form *e .jned for use on elite f 12•pitchit`1yp® <br />SUSD FAC PLANNG Q002/003 <br />bee instructions an back at pa9• Department of Toxic Substances Control <br />Sacramento, California <br />j DO NOTW E Bf-W <br />EI v f nfa antic. <br />TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />(Generators %vhc submit I,ozardous waste for transport out•al-stole, <br />produce complexed copy of this copy and send to DTSC within 30 days) <br />ZV OG J® <br />h. Ge is US EPA ID No,— Manifest Document No. 2. Page 1 <br />Information in the shaded areas <br />UNIFORM HAZARDOUS <br />is not required by Federal law. <br />WASTE MANIFEST <br />W' tl e e M P 51,1110 of <br />i <br />3, Generator's Name and Marling Address . + <br />A. State Manifest Document Number <br />919631051 <br />Ml6/V. iat!It. 4.1 at 61•s •a^`•I.MVr. 4Jr+411 s`�\- �rlr�\�•4rJ�; lrrl� <br />•°>ts <br />Iis" N 1--t &-*ua 4JV --...s -- " i C 4 Oa°i <br />8. State Generator's ID <br />A. Generator's Phone ( �e"n�• \ '..-"_--•�•••"� !'cL.i.^ �rdvetterff <br />- <br />_ <br />5. Transporter 1 Company Np' 61U ifiPA ID Number <br />C. State Transporters ID Reserved.) <br />Z L! D J <br />D. Transporter s Phone <br />'°aG' ""1393 <br />".389 "• 1 t <br />j' YP <br />7. Transporter 2 Company No EPA ID Number E. State Transporters ID (Reserved.} <br />t <br />_.J F. Tronsporter's Phone - <br />9. Designated Facility Name an i e Address 10. US EPA ID Number G. State Fociiity's ID <br />i7tl �'.p6i eft%..�„1P ilifi T <br />s'T-i'Fr s e'er..,rat �+ r•, H. Facility's Mne <br />-... -- <br />.. ^ ••e, ... !'f 9 e iP 5 <br />4121 • 2® !4 1 uA RA m 4: <br />w :m..:i1�+ r rt.J"r"Ns e n � P,t <br />2N ,..h <br />12. Containers 13. Total IA. Unit <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) No. Tjpe Guonity WI/Vol 1. Waste Number <br />State <br />�r•. .; e• r -a t c rn a r�/'\"`r a -+P^• u <br />vvaz$ ret: t" Id:3dtiiTTd:tEJl4: d--6i.Ia184•%'•+'+• dd.tJ.:J.J_ 0.Jdei It a" i'43 :t <br />ryg ss <br />- <br />- <br />EPA/Other - <br />(7«. <br />.•.wl .... ax•` .f' 'tt..-$. ;t!'"lr_a •. <br />t'^'.'0 lJrr^elft s !e'.1li •!E? Y.`. `1. I <br />L,' rt� <br />\ <br />T <br />.'eta kti <br />E <br />State— <br />,.,. <br />N <br />b <br />. <br />EPA/OlWicr <br />' E <br />R <br />A <br />Slate <br />c. <br />EPA/Other <br />o ® <br />R <br />State <br />3 <br />d <br />i <br />EPA/Other <br />aJ <br />K. Handling Codes For Wastes listed Above <br />J. Additional Descriptions for Materials Listed Above <br />C. <br />d. <br />15. Special Handling instructions and Additional Information s,,,,q •' '� ((///.•������ <br />'M -4 <br />sM eCe[.®i <br />�s d.•.a k !' <br />,bA�B^h4 �.f'4 t..1'iyi�4 �►@s[:1•ce;�;4tA!!^ Ct3'T.R94}tfeT�.i®sa tltlt s�ilG:. lle�`R�ilellt 76..� !N -ell e�! N�1lY�.Qe14 f'.9 >sB L•i E <br />JAPs ! d4 4 4 '71^ d /^ 8 +i® <br />Leoldp`stt lir isuAt®o s s aFGe sc e- o 'Ec.i iaisalti it�e c�ip�Sl .♦>2wir$i/�i@� <br />1 <br />HLSUs 4=iAC7,i11Cs:a.y wyG/► <br />4. A 75(:05 <br />►f Ell <br />O A..' t. A [i•.e m«f r.". <br />Pr ♦ �''¢e�� r.� ` g,,, D tf is r1e2 a.- s �.tL w. s `inn -P <br />Unified A\ -S T[..eli> (.�tlJEr SR..1rMrA 1-.. 9.Y r <br />i <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 />highway to applicable international and notional government regulations. <br />marked, and labeled, and are in all respects in proper condition for transport by according <br />I <br />If 1 ar, a large a,uonNry generoror, call <br />I certify that I have a program in place to r uce the volume and toxicity of waste generated to the degree I have determined to be economie( <br />the and future threat to Kumon health <br />and that 1 hove selected the �racticoble method of treatment, atorag , or disposal currently available to me which minimizes present <br />select the best waste management method that is <br />i <br />practicable faith effort to minimize my waste generation and <br />and the environment; OR, if I am a small quantity generator, I have made o g <br />t <br />available to me and that I can afford. <br />Month Day Year <br />Printed/Typed Nome Signoture <br />rp <br />': <br />T <br />17. Troon rler 1 Acknowled ement o Receipt of Materials <br />Month Day Year <br />R <br />A <br />Printed/Typed Name Signature <br />, ..r. ` <br />$ <br />i S <br />- ✓ <br />r / <br />P <br />' <br />.Trans iter 2 Acknowled ement of Recei f of Materiels Month Day Year <br />R1 <br />T <br />Printed/Typed Name"" Signature <br />Pri <br />19. Discrepancy Indication Space •. - f< <br />F <br />A <br />C <br />I <br />' <br />L <br />f <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered b this manifest exce t os ofe in Item 1 Month Day Year <br />j <br />Printed/Typed Name Signature `.� r/ <br />1/, <br />Y <br />_71d <br />. <br />j DO NOTW E Bf-W <br />EI v f nfa antic. <br />TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />(Generators %vhc submit I,ozardous waste for transport out•al-stole, <br />produce complexed copy of this copy and send to DTSC within 30 days) <br />ZV OG J® <br />