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MA`1'-12-2005 13:49 FROM:TRACY T CK 8 AUTO S 12098325307 ke <br /> 683433 P.6 <br /> Stote at Colifcrnia—Environmental Protection Agency <br /> Form Approved Will No.2050-0039(Expires 9'30.99) See Instructions on back o t5. Dop meant of Toxic Substances Control <br /> Please print or typo. Form designed For use on alita(12-pitch)typowriten Satramettta,California <br /> UNIFORM HAZARDOUS 1, Generator's US EPA ID No. Manifest Document No. 2. Page I Infatmttliwr L,the shaded arena <br /> WASTE MANIFEST is not required by Federal few. <br /> 3 122.11 ary <br /> 3 0enerator'a Name and mailing Address Yy 1� A •J �;t 'T-tap A. Srdto Manifest Document Number <br /> 24064-677 <br /> S. State Generator'sIf? <br /> sh j <br /> A. Generators Phon.20 <br /> Ia <br /> 5. Transporter 1 Company Name 6, US EPA ID Number C. State Transporter's IDull <br /> f rued.} <br /> Cy p Cettry®®�y, �.�,� S+ .�1a Q10 10 10 7 .� D, Transporter'a Phone <br /> 7. Transporter 2 Company Name - 8. US EPA ID Number E. State Transporter's ID(Reservo .} <br /> 9. Designated Facility Name and Site Address 10 US EPA ID Number G. State Focility's ID <br /> ALVISO INDEPEND91"IT OIL IQ 101 U <br /> Q �I: <br /> MARCHER StITT H. Fa4ility's Phone <br /> 9 2 IC JA IL 10 10 10 1116 1.11714 13 (51Q 6.1140 <br /> q p 12. Containers 13. Total 14. unil <br /> 4 V 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Tyea Q_uonti wi/VoI I. Waste Number <br /> ee a41 C. a: t 1 - 1ati-jam'` T slat;"c <br /> E t NON IRORA HAZARDOUS -- <br /> WASI'T,SOLID) �') EPA/Other <br /> d r t <br /> N b. State <br /> coGo <br /> E -- <br /> N R EPA/Other <br /> A c State <br /> o T <br /> 0° O rAA EPA/other <br /> R 7 ate -CES-SAW UA. <br /> d WAS f�C _� �.. .. __. state <br /> v }ZED <br /> EPA/Oihar <br /> w <br /> Z ). Additional Descriptions for Materials Listed Above """"" K. Handling Cortes for Wastes Usted Above <br /> 2Vb <br /> 1 y <br /> j/AC,, ty 1 t. <br /> t� A!^,r"'. ' �`V•V..., lam. d• <br /> J <br /> 0 15, Special Handling Instructions and Additional Information <br /> Q <br /> Z <br /> WEAR PPE 24 HOUR EMERGENCY KIRK HAYt� o mo-47s mo ERG <br /> W <br /> 16 GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping norma and ore elassifiod,packed, <br /> marked,and labeled,and aro in all respects in proper condition For transport by highway according ro applicable Intertranonai and national govarnment regulations. <br /> IF I am a large quanlity generator,I cerfify that I have a pr earn in place to reduce Ike volume and toxicity of waste generated to the degree I have determined to be economical) <br /> CL practicable and that I hove selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> and Ike environment;OR,if I am o small quantity generator,I have motile a good Faith effort to minimize my waste generation and select the bast waste management method thol is <br /> available to me and lhal I can afford. <br /> O <br /> >. Prinfed/Typad Name <br /> Signalu a �Month Da� Year. <br /> T 17 transporter 1 ACknawledgement of Receipt of Materials <br /> R. <br /> LU L ri ad/Typed Name ( ig a Month Day Year <br /> w a <br /> 1 <br /> Lx. u e. Trans rter 2 Acknowled eenr of otos mf' oterlals �^ <br /> 0 T mPrinted/Typed Name Signature Month Day Year <br /> W f <br /> to R <br /> v19. Discrepancy Indication space <br /> z F <br /> — p <br /> C <br /> 1 <br /> L <br /> 1 20 facilitZ Owner or Ocierator Certification of receipt of hazardous materials coveb this manifest excn s qtad in( 9. <br /> T Prink /Typed Name 1 t ignat a month / Day Year <br /> r X11 V V <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow- TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br /> DISC 8022A(1/99) (Generators who submit hazardous waste for transport auf,of-etulu, <br /> FPA 870f),-77 produce completed copy of this copy and send to DT5C within 30 days.) <br />