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i <br /> State of Colifornia-Enviran mental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back age 6. Department of Toxic Substances Cont <br /> Please print or type. Form designed for use on elite 112-pits pewriter. Sacramento,California <br /> $ 1. Generator s US EPA it No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal law. <br /> WASTE MANIFEST of <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number. <br /> i i-.l.'V,' i`i..J+;CzK:;, I.IvC. ! 4 <br /> O �,: ,i I��`sdk�<rl.dh l.l`.? '.`.i t'I2i'.3.; B. State Generator's ID - <br /> h <br /> to 4. Generator's Phone �� 3161010161119121 <br /> t\ <br /> LO <br /> 04 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserve .1 <br /> cp <br /> q D. Transporter's Phone <br /> O �•f <br /> 6 :;; C��.,4`1°f.IF?'F f''.�'�: (. r": 1'C 1:�1� ri? Vl k'1 �.1 .! }�? tip .� #3*17 748-: <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.) <br /> [a)U F. Transporter's Phone <br /> 9. Designated Facility Nome and Site Address 10. US EPA ID Number G. State Facility's ID <br /> QO Z <br /> e�rO1''dS t r' I<..j:�i f:. H. Facility's Phone - <br /> t u- <br /> rI I r i <br /> u- <br /> "v 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 1 12. Containers 13. Total 'IA.--U-nit- <br /> Z <br /> No. Type Quantity Wt/Vol 1. Waste Number <br /> a. <br /> = State <br /> t- 1(f;, it.f: .r4.'li)�.1; �ljll .CiiiLr'f'ttN L'. {!1}�ti',:u Ilt; l 1%t�j'i�4l., lik{;!I`r'f! <br /> 792 <br /> 3GU ` T P j,-AO EPA/Other <br /> o DIM <br /> N 6. State <br /> opo E h, ar,, t i:it f lsl li9i;d'!.1 I 11!• tirJS,f!S"li")? r, bi 5i.v Fui: r!il{r1%! Iitit;i <br /> J <br /> re y EPA/Other <br /> ct A yl 7 1' !^��} ry G <br /> o T ` State <br /> 010 <br /> 0 Q j�'„ iii,!. .;?:%QN i n!`.1; 'SO h,'vT1Gi�Rf;Y1 iC <br /> R airy. i1l. ;'tti EPA/Other <br /> � d. State <br /> Z <br /> �i,r:c5 �r' r`!'1it ?;1, .l.i Yfbfiu; '! te,1JP't' rt>f{ i± ff' <br /> �t 11 EPA/Other <br /> w <br /> Z J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> O �1 y"91e&�4..CW (i1'I7 CHRI IC A011 - MAMA RATHI,1 (L) dj : <br />