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r <br /> State of California—r+vironmanhsl Protection Agency <br /> - Fgrm Approved OMB No.205Qk:039(Expires 92V-991 See Instructions on back r -'19e 6. Department of Toxic Substances Control <br /> Please print or lypo. Ferri,designed Far use on elite 112-pirw_' xrite'. a' `,J- Sacramento,California <br /> UNIFORM HAZARDOUS Generaror's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST 215 3 1 of 7 <br /> 3. Generotars Name and Mailing Address A. Stale Manifest Document Number 23812531 <br /> S IyL'�KZWJ"JRNKFV-ti[?LUTIL?Nl: - - <br /> 0 4tlra IFM I5TRML.PfM ORNE mAN(LCA,cA 9L1837 B. Stale Generaror's ID <br /> n A. Generators Phone 1 M1 P2541= AJIM01)KAPAA1_ - <br /> cV 5. Tronsportgr I Company Name 6. US EPA ID Number C. State Transporlefs ID[Res., .1 <br /> .co w /p /p e� g ,mss <br /> mo Ranice5 Environmeektall SeFVices Fj�q4 4 y y 3 5 6J 6 D.-Transporter',Phone - 916 371-5747= <br /> 0 <br /> 7. Transporter 2 Company Nome 8. US EPA ID Number E. Share Trohspornef.ID Reserved.j <br /> QI I I I I I I I I I 1F. Transporrors Phone <br /> r1 U Facili Nam d Sin Address 10. US EPA ID Number G. Stara iii '4 <br /> n d 13acE^-Wes I&t a fICS&ery <br /> v ���JQ E. Pico BIYr3. H. Facility's Phone' <br /> �O L.os Anneles, Ca. .90D23 C .A G Q 08262406 - ';.. .800-499-7943 I. <br /> 12. Containers 13. Total 14. Unit <br /> < 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) ----N—.—--F Quantity Wt/Vol I. Waste Number <br /> LI <br /> \1__ 41ia5te FlammableC'IigLFid�s,nq.oww.s.,3jJNi�l3,PGiI States a <br /> 3 G {tlRnners,'nilS) l=€2�i'O[� 7G4J PH <br /> D O EPA/Other D)01 <br /> o N L state' <br /> m E <br /> coR EPA/Other <br /> 'a A c State <br /> T JUN O 12004 <br /> R EPA/Otho <br /> w d. -- ----- State <br /> Z BY- ------------ <br /> - <br /> V EPA/Glher - <br /> w <br /> it Addiliwa)Descriptidal for Materials Usted Above '. � K. Handling lodes for Wastes listed Above <br /> 0 /lea: q K 15t644c D�5 a. <br /> N V 1 <br /> Z „ egeaasd�anol Information <br /> 41 <br /> wkCC 1KHIN <br /> Z 24 1,4R. EIVIE-FQ <br /> dGENCY CNTACT': 918-371-.57d7 Job# PrtAe* <br /> 400 INDUSTRIAL PARK DRNE, K9`%jTLC.A, CA. j PSON1223 <br /> s o�'a383d <br /> X16.-GENERATOR'SCERTIFICATION: I hereby dwlara that the contmhof lh consigement era(oily and ac<eraroly dexribad obo eby'proper bip ingnamep d are dossiBed,Packed, <br /> V marked,and,Ibbeled and are in all respects in proper condition For transport by highway according to applicable,international and not <br /> ionaPgovernmentPegulations.--. <br /> J If I a ge quam q generator,I ray that I have a p ram hu:place to educe themead toxicity of waste ge ted to the degree I have determined to be economically <br /> N prat(c tole and)hat h e selected the ggra<t 5 big m�th�of treatment Nq{ags,ot,dispo d rently ave IabYe to me which m n mrzn the present and furore threat ro h mean h= <br /> "" 9fn8 t, a v`i.nmenP OR,if fain 6 small quantity generator,I have made a good faith effort to mhnhdd;e my waste general oa and select the best waste management method that is <br /> �- available to me and that I can afford. - '- <br /> y0 Printed/Typed No.. - Signakne 4 `Month tDay Year <br /> ZZ3 T <br /> w <br /> N 17. Tress rter 1 Acknowlad amenl of Receipt of Materialsm Nronth D Year <br /> MW E Prinrod/T ed Na SignaNro .O <br /> LL 0 18. Trompoerter 2 Acknowledgement of Receipt of Materials <br /> O i Prinbd/Typed Name - Signature Monts D% Year <br /> w E <br /> Q R <br /> U F 19. Discrepancy Indication Space <br /> Z A <br /> C <br /> L <br /> 1 20. ili C Iwner or.0 aror Cerlifi<alion of rwei t of hozardous mabriab covered this maniFast ax<a 1 os noted In Irom 19, - <br /> TPrinl yp. Name � - SignaNre —__ /4dpnDay Or <br /> DO NOT WRITE.BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> (Generators who submit hazardous waste For transport out-oklate, <br /> DTSC 8022A 11/991 <br /> produce completed copy of this copy and send to DTSC within 30 days.) <br /> EPA 8700-22 <br />