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_Jan- 14-03 12 : 22P Wendt Construction 209 547 9310 P _ 03 <br /> Fane^pproved OMS No 2430-0039{E,rprres 9 3p 919) See instructions on back of page 6 Department of Toxic 506stonces Control <br /> Please pnnl or type farm designed for uae on elite 112 p+tchl typewriter Sacramento California <br /> UNIFORM HAZARDOUS I Generator s US EPA ID No Monileet Document No 2 Page l lnformotion in the shaded oreas <br /> is mar required by Federal law <br /> WASTE MANIFEST 1710eml 71711 <br /> F 1 ,91 /of/ y,y <br /> �l Generator <br /> sSml�n nkln Address r ',`y <br /> xrvlo19 <br /> I Generator's Phone l _ 7� r <br /> J r s � al <br /> 5 Transporter t Company Name b US EPA ID Number fia'$lole'rP9sls <br /> n � <br /> pm <br /> Cj <br /> 7 TranspoV 2 Company Name 8 US EPA ID Number <br /> J 9 Designate¢Focilay y�me ono�tle s 10 US EPA ID Number Hate l ,e i t <br /> �C vi'JJ/ Y- <br /> e r <br /> eC <br /> arc ryry C St IIS{R s s <br /> _ CA /5� ' ' <br /> I``w % ?y/r lel s t ' <br /> I g 1 3 US DOT Descr+ptron lmdvding Proper Shipping Name Hazard Class orsd ID Numberl 12 Container) 13 Total 14 Unit <br /> No Type Quantity WI/Vol I West*Nul l'w <br /> Z o /� J /arAi /!/s Lt✓d rr .l��� Slots ' <br /> T <br /> EPS/ <br /> o N 6 Mals s = <br /> 0 E <br /> v R RPA/Olber a f <br /> ILI <br /> CV A a <br /> O T r state <br /> m O <br /> w <br /> Z d <br /> til a <br /> W �+ <br /> U <br /> w <br /> ZJ Additional Descriptions for Moterfo61 L+rAho"d AboK Handling Codes for Wastes listed Above <br /> O I )f` 0 6 <br /> 14 <br /> ,;� , 13s` tit +C t f r id, <br /> q �s <br /> Z rleli;13 Special Hon ng Instr trona A#Pltorisl In emotion , <br /> e0i.11111 PRE-, <br /> 16 GENERATORS CERTIFlCATIO I err6 declare that the[anMnlr of this consirment ore full and occurolehr,de ter i6•d above 6y proper sh+pprng name and are clau shed packed <br /> morked and labeled and are m all respect.rn proper condition For trarnporl by highway according to Opprlcoble international and notranel gavernm•nl regulations <br /> J <br /> am a torp,quantity generator I certify that I liare a program in place to reduce the volume and tonicity of waste generated to the degree i have determined to 60 eeanom+Cnll <br /> a rocnc064.and that t hwe selected 11t.prachcoble method of treatment storage u do wal current) avail ble to me which mrnrmr:es the F.P.ro threat human <br /> and the envganment OR if I am o small quanl.ty generator I hove made a p od fouh effort to minimize my waste generation and select the beat twast•monogemee!method 16011, <br /> « orailoble to me and that t can afford <br /> O <br /> yPrimed/Typed Nome Srgnohrre r Month Day Year <br /> w <br /> C <br />(D t 17 Trom otter 1 Acknowled •mem of Rena t of Matenols <br /> 1 <br /> ii 1 P Typed Nome Stgnatur Month Day Year <br /> r <br /> t _ 9 p <br /> Q 0 18 transporter 2 Acknowled ■mann of Receipt of Materials <br /> 1 Pr+nled/T ed Nam• <br /> 1 YP S+g notes» Month pay Yeor <br /> us E <br /> a ` <br /> VF 10 Discrepancy Ind+col+on Space <br /> A <br /> C <br /> I <br /> L <br /> l 20 FacilityOwner or O eratot Cerhf+eatron of recen i of hazardous materials covered b this manifest•nee t a.mooted in Item 19 <br /> T Pr rated/Typed glome Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE <br /> 22A fl/99l <br /> EP 00--21 Yello- GENERATOR RETAINS <br />