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`MAY-12-2005 13:52 FROM:TRACY T ' K & AUTO S 12098325307 •4683433 P.10
<br /> EOM Approved OMB Na.2060-0039(Expire,9-30"99) See InstructianX backa 6.
<br /> Plooso print w type. Form dnalaned/a•use on*Alfa f t 2-pirc typewriter g Doparimont of Toric Substances Cem,>
<br /> Sacramento,California
<br /> UNIFORM HAZARDOUS 1, Generator'&US EPA ID No. Manlfed Document Ne. 2. Pally 1 Information In the shaded arras
<br /> WASTE MANIFEST c, Pi 1, 1�± 0 12 2 1 8 8 1 6 a F 6 is not required by Fedarol law,
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<br /> e` UN87AAIUAUIC7dtp��' A.•"SuriI/jfe,rDacumQnl.Alwnber.. i
<br /> 3W N. TRACY BLVD
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<br /> }RACY CA`A ' '-
<br /> 4. Gonoralnr's Phone I $32.:3 �+ `
<br /> cel 5. Transporter 1 tampons Name
<br /> 6. US EPA ID Number 1115. 'y{p:l e )
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<br /> © BURY ENMRONMENTAL SEMAMS C JA £ 0
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<br /> 7. T'ransPorler 2 Company Nomw
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<br /> 8 ty amp and Slte Address 10 US EPA ID Number ',�,�t'Ct Sayre,Fyoi ly"a'tf1 �
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<br /> 7a 3650 E,26TH STREET - � '� . -'. . ,,
<br /> LO.2 LOS ANGELES .^.A 9M23
<br /> U 11. US DOT Daseripllen(inducting Props Shipping Name,1`1026M Bloss,and ID Number) 12, Contolrws 13. Total 14 91n1t•,� ^ ^^' 4s 4 r 4 ,,,
<br /> N_Z a, No. i W, ©uantt 1�1/�pyln '.fv: ,osFe.�Yy r:
<br /> NON-RCRA 14AZARDOUS WASTE, SWD(ABSORBENT,DIESEI,
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<br /> Q 15. Spacial dandling Instructions and Additional Information
<br /> USE PPE EMERGENCY CONTACT°MIEL HARPER
<br /> NAER11A. Irl (sI0 501a
<br /> 16. GEN TOR'S CERTIFICATION: I hereby declare that the contents of this consignment aro fully and accurately described a {»
<br /> < marked,and labeled,and are in all res is in proper condition for transport b highway Odin la applicable international nd hat®I ng name andore regulations. pocked,
<br /> („) Pec PrP P Y g Y $ PP• govnrnmenl rogulationp.
<br /> if(am a large quantity generator,I certify that t hmo o pro
<br /> grom in place to reduce Iho volume and lu,sicity of waste generated ro the Jnroe I have determined to bo ecanamicall
<br /> y practicable and that I hove selected the practleoble method of treatment,steroge,or disposal currently avoilgble to me which minI ices Aho yy
<br /> and the emironmenl;OR,if I am a smell anti pres8111 and fetttrro thtmt to human hoot
<br /> ® 9s N generator,I heap trade a goad faith effort to minimtse my waste gonerel6n and select Ihy last waste mtr etnent math
<br /> available to me and that t can afford. tad that is
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<br /> Month py, Yea[
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<br /> (� T 17. Transporter T Acknowledgement of Receipt of Materlals
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<br /> LLJ N Printed/Typa Noma .. Signature
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<br /> si O 18, Tran rt.r 2 Admowled m of Reeei t teriale
<br /> EPrinted/Typis d Narne Signalure Month Day Year
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<br /> V F 19, Discrepancy indication Space
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<br /> I 20. Facility Owner or Operator Ce Italian of reeei I of hazardous maferiols covered hk this manifest once i as noted in Item 19,
<br /> YFrintod/Typyd Name Signature Month Day Year
<br /> DO NOT WRITE BELOW THIS LINE.
<br /> DTSC 8022A(1/991 Blue? GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS
<br /> EPA 8700--22 To; P.O. Box 400, Sacramento, CA 95812.0400
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