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08/29/2003 FRI 05:48 FAX 661 393 3834 MP ENVIRONMENTAL—BAK 11002/006
<br /> Seale of California—environmenlai Projection Agency
<br /> Form Approved OMB No.2050-003P(Expires 9-:30-99) SBE Instru4Flons on bads oe 6. Deponmenl of Toxic Substances Control
<br /> 'Pledse print or type. Form designed for use on elite(f2'p pew 11ar.' 00
<br /> Saeromenio,California
<br /> UNIFORM HAZARDOUS 1, Generators US EPA ID No. Manifasl Documanl No. - 2. Page I I inninorion in the shaded oreae
<br /> I s not required by Federal low.
<br /> WASTE MANIFEST � % - � "� of
<br /> 3. Generclor'i Name and Mailing Address rlw � INC. 'A:51,la Manifest Document Numbor;
<br /> dB:Slale,Ganerarofe IV. I'
<br /> �� � � bQ, CA 93704—.
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<br /> A. Generator's Phone "
<br /> 5, Transporter I Company Name 6. US EPA ID Number C-:Slate TronspQ(far's ID(Re'ery ,1.
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<br /> F:„Tronpporter's Phone, }` }' , _
<br /> �I V 9, Designated Facility Name and Site Address 10. US EPA ID Number G, Stale f4�ity's ID
<br /> 30a CROSBY AND OVERTON : ;' r_'_'. '
<br /> %,"� 1630 Woo 17TH ST H: Faaliy's Phone"
<br /> 11. US'DOT Description fineluding Proper Shipping Nome,Hazard Clgs,and ID Numbarl ig, Conrpinars 13. Total 14. Unit
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<br /> RQ WASTE F IMS LIQUID, 90S' 3, UN1893,- 600
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<br /> 0 15. Special Handling Instructions and Additional Information
<br /> z EMERGENCY PHONE' M) 4583
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<br /> .�., 16. GENERATOR'S CERTIFICATION: I hereby declare Ihoi the contents of Ihls consignment ore fully and oaeurattlyy described above by proper shipping oms and are elassifled,packed,
<br /> < marked,and labeled,and are in all reapects in proper condition for transport by highway according to applicable iniornnlional and national gevarnmont ragularions.
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<br /> If I am a Iprge quaniilygenerolor,14eriify(hat I have a program in plate to Caduca the volume and laxicily of waste generated to the degree I have determined to be economically
<br /> praclicobla and Thal i hero selected ihP praclicahla method pry
<br /> IrealmQnt,slgrpge,Pr d17PPi0I currently avyi146Ie Ii n1N wlsiC{1 nliniPMCUe Ilia,Present pqd fvlyr0 threat W human hoahh
<br /> and Ike environment;OR,If I am a small goantlly genetalotr 1 have made a good faith effort to minimize my waste generation and select the best waste management method that is
<br /> Q available to me and that I can afford.
<br /> UPrinled/Typed,Name Signature - Month Day Year
<br /> Ve R 11. Transporter I Acknowledgement of Receipt of Materials
<br /> W R Pri ted/Typed Name Signa re Month Day Year
<br /> 0 1®. Trons prtgr 2 ACknPwfed emeni o Reeel t of Materials
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<br /> fi Printed/T ed Nome S nolura
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<br /> IF[J 19. Discrepancy Indication Space
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<br /> I yp, Facilily Owner or Q Q(PIPr CerliflC011gn of receipt of hazardous materials covered 6v this manifasl axca t as noted in(ram l9, '
<br /> T Prirdad/Typed Name Signature r' Monrh Day Year
<br /> DO-N T WRITE B OW THIS LINE.
<br /> DISC 8022A-0/99] Fi
<br /> EPA 8700-22 Groon; TRANSPORTER RETAIM
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