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I <br />State of California—Environmental Protection Agency <br />Form Approv <br />Pleased OMB No. 2050-0039 (Expires 9-30-99( <br />'.atm e print or type. Form designed for use on elite (12 -pi ) ter: <br />See Instructions on back of page 6. <br />P 9 Department of Toxic Substances Contra <br />Ask Sacramento. California <br />DO NOT NROr BELOW THIS LINE. <br />Green: TRANSPORTER RETAINS <br />UNIFORM HAZARDOUS 1. orators US EPA ID No. Manifest Document 2. Page 1 Information in the shaded areas <br />is not required by Federal law. <br />WASTE MANIFEST lit 42 of At <br />e: <br />3. Generators Name and Mailing Address A. tate amfest DocurAnt Number ; <br />-. <br />ry/�a^e^' e*se°' l'a a�'rnssl! s-rar'•.s.# ee4^- �' a� w xr e.J n eatw• carr. <br />,fl.t a..toV1,. VIV t etty/ege t luso e.N../" r d .,rs•esv .r 1✓raWtJet e' eta ►flees• C ,aa t a., <br />r^;a's, 60A BLDG iiia aI`.s4,eKTj01.4 .,CA X5266 wQ'fi® �' B State Generator's ID <br />A. Generates Phone j a�n <br />Iie1A..#ft5tsi <br />ldlaa ti`>w>w sass r_anrs <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporters ID fReservad-j <br />D. Transporters Phone <br />1+`e"ahi I"s Ih\I /'. I'\wsTW hr /e Je•aJ +.n 4'•t�sf+h Jl A eh A h I`' ap ^ +0 !► <br />6..4r4J0.1..4Ly1 VViMaeYVL tltlVVa?bl\J6:..2 <br />- <br />- e �' <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporters ID [Reserved.] <br />F. Transporters Phone <br />Site Address 10. US EPA ID Number <br />9. Designated Facility Name a9(.. <br />G. State Facility's ID <br />s-COI_OGY C10 sft1114DUS)lRIF S <br />t JT7D C!CVr -!f AV2, <br />H. Facility's Phone <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and tD Number( 1 Containers <br />13. Total 1 Unit <br />No. <br />Type Quantity Wt/Vol I. Waste Number <br />a. <br />State <br />F�„�i��('a` IWiY\j1'II_£:?f�:�r"1l..IA.1t� 'r'Tt�o�?�• 'T,�I�ff� <br />�F=� <br />��, <br />EPA/Other <br />-fir+ <br />f�-1 <br />E <br />N )n -'tom t� R A H 7',. ;•r t f 1 -?5, Waste scilr <br />i <br />Y-- <br />N <br />b. <br />State _ <br />E <br />EPA/Other <br />R <br />T <br />`' <br />State <br />EPA/Other :r <br />R <br />R <br />-. � <br />d. <br />_._ <br />State <br />r <br />EPA/Other <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes For Wastes Listed Above <br />f t� tt4{9 ?F.,1sd:;t?F tt I?,!0'- Yr fit.., -3., 1 Af6;N :; ptr 't•'- rf -*1T�cjt't�t.Ei� <br />a. b. -- <br />c. <br />d. <br />4-` <br />15. Special Handling Instructions and Additional Information <br />VVFAR APPROPWAfE PP.9. WHILE HAND[.ING, SITE. Doic-srt, RI_OG-1,00 <br />!W t'•t^'1^^r.l v^ er��,rn•1 § sisJ J•iA!ag-a.wt-e• <br />fsty{# fly P"w�6 P`P'9 r"���^^nIJ^•�-# TTEt f .-yt g�a I aP^ Ru [ca0;*p' q2.a -4`46 -1, <br />2A '"'OUR <br />4''i' F'F�V� GBYIF,'.0\t3G6�`Ls ! F G/..GF"i'FhJfi6tC tf• (1s0.f6J � eA.4 ! "slk►J ,� 6.J�F"tsF104st: iJi.3 ! 4i1C.3t1 k F4/i i s.it ;R"' 4J 1 <br />9009 1 ATIAROP CA 953310 <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, pocked, <br />marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br />if 1 am a large quantity generator, I certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be economical)y <br />practicable and that I selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and Future threat to human health <br />bnd the environment; OR, if 1 am a small quantity generator, 1 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 1 can afford. <br />Printed/Typed Name Signature' Month — Day _. Year - <br />T <br />Ole 44�.e <br />17. Trans r ckn ement o ec t o terials <br />R <br />A/Typed <br />Name Sig ure Month Day Year <br />IN <br />041!�_ A L: 01Z el I <br />P. <br />R <br />18. s ckn ement A R ei o feria i <br />RPrinted/Typed <br />T' <br />Name ' <br />Signature <br />Month Day Year <br />E <br />19. Discrepanry Indication Space r <br />A <br />9Y <br />C <br />L <br />1 <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br />Mnted/Typed Name <br />M-41 <br />Signature <br />Month Day Year <br />J4,1 <br />DO NOT NROr BELOW THIS LINE. <br />Green: TRANSPORTER RETAINS <br />