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State of Colifomia—Environmental Protection Agency v ' Foran Apploved OMB No.2050-0039(Espirito 9.30-99) s • '_ ; See Instructions on back - pge 6. Department of To.ic S.bstonces Contra Pleas print or ype. Form designed kr use on eliR�h.pib�,pewribr.'�.w. Sacraments,California UNIFORM HAZARDOUS I. Generator s US EPA ID No. Manifest Document No. 2. Page 1 InFormation in the shaded areas WASTE MANIFEST 2 ,, dry is '��fYnc,Ns - s+ of not required by Federal loe. 11,018�1 A. Stab Manifest Document Number 23812532 4001NDLISTHJAi_ PAFU(DRIVE-MANWCA.CA T O B: State Generators ID n 4. Generator's Phone 1 2W)-^254=12d ;'413n. AHMl10 KAMAL h5. Transporter 1 Company Name ,/�6. US EPA ID Nuwmber p� /� +y 1 515 �+ C. Stole Trans rfier's 10 Res I+2bIMM EI1V1f4rlmtntal Service-, ys y ® M 4 t) y ty 1p D. Tmnsporkr's Phone 16_ 371-_5147 O 7. Transporter 2'Company Name B. US EPA ID Number E.SbTranspbrkrs ID(Reerved.] - '»U F.Trampon e.Phare $" n I0. Us EPA ID Number G. Sb a s Q �11'el'P19Y��"bR9�,d��R e.itt kw. 3M281 Old SkIffte Road �1 00064611 � /y R o KCLtleman City. CA �r 0 0 0 6 4 6 7 1 t H. Facility',Phone `l .4 r 9�DY jO Q 11. US DOT Description cludin Proper Shipping Nome,Hazard Class,and ID Number 12: Containers 13. Total/ 14. Unit l- V p ton R P PPi^9 ) Plo. Type Qaantiy' Wt/Vol I, `Nast.Nu/ V= W)N RCRA Hazardous Waste Solei 3 G (epoxy Compound) ERG'00 # 1710 / 101,010P EPA/cher E WN b. entre 'a R li_�j v EPA/Other a 'A f� ) o T c. .State O 114 m R EPA/Other - - w d. EVA/Oth State W Z J. Additional Description,far Moteriab Listed Above K. Handling Codes for Wosbs Listed Above O ��, 1• yX�5�4C fpm S o_, _ b _._ N D.. K 0jeaLaChldp� �l stncira �nal Information F h ODIC. 1IV'�ILViSLJ. Z 24 HR. Eb/ri!<-"RGENCY CONTACT: 918.371-6747 Job# FTDfde# W - 400 INDUSTTR.IAL.PARK DRNE., MAM'ECA, CA., J DZ 2824 ci o�,383a 16, GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accuralely describedabave by propership ing name and era classified,packed, Vmarked,and labeled,and are in all respects in proper condition For tr msport by highway according Io applicable international and national government regulations. If I am o large quantit1yy generator,I certify that I have a program in place to ro ce the volume and toxicity of waste generated b the degree 1 have determined to be eco nom. 11Yl• ,ydj Q practicable and that(hove-selected the predicable method of heaMant,storage,or disposal currently available to me which minimizes the present and furore threat to Itoman h.olth and the environment;OR,if I am a small quantity generator,I have mode o good kith effort 1"immize my waste generation and select the best waste management method that is O available to m.and that I can afford. } Printed/Typed Nam. Sig^.tore - Monlb Day Year W /-\-HT '1AD i�l� 'AL _ D S :210 Vr T :17. Trans iter 1 Acknowledgement of Receipt of Materials R us L Prinhd/Typad Nanta sigpatm Month DayY. W p 1015 y 0 0 IS. Trans rbr 2 Ack..M d .meat of Recei 1 of Materials `T Printed/Typed Nanta E Signature Mon11t Day Year W Q R V F• 19, Discrepancy Indication Space Z A C L I 20. Fadll Own or aor C cation of recei 1 of hazardous materials covered this manifest once s ted in Item T Printed/Typed Nam r Signature \ oath Day �Y Y t 1/ — C DO NOT WRITE BELOW THIS LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. DISC 8022A(1/99) ]Genera tars who submit hazardous waste for transport out-ol-stab, EPA $700-22 produce completed copy of this copy and send to DTSC within 30 days.)