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Form <br />amre Or <br />Approved <br />SOI}forma—tnvtronmantal Pr~;on Agency <br />OMB No. 7030-0039 (Expinu 9-30.99{ <br />Please <br />See Instructions on bock of 6, <br />print or type. Form &,igned for use an alit (72- inett F - <br />p J typewriter, PtpatMxnt of Toxic Substances Control <br />'X) -•56H Sacramento, Califortio <br />UNIFORM HAZARDOUS 1. Csensrator s US EPA ID No, Monllesf Document No. Z Paga 1 Infertrat�m in the s iocltd areas <br />WASTE MANIFEST a nor required by Federal low. <br />C .R R O 0 2 1 3 8 � R 5 O �) of 1 <br />3. Gane,asw's Nome and Moiling Address Ski*#4* " <br />so <br />127()() t (1�(�1(,'H A�2rvr hrm,, JIM MItiT'r'1M K'V 24(x: k sktv'04aere�rp)ta.. <br />h <br />A.C"I Gaanperpattorr'elPhom H()tjk )1i J*A 77'()7 )x#'74.... tt) rfT Aliy� �q1 <br />of <br />r �'�7'1( amgo«« t4r s 113 4 Nis <br />6. US EPA 1D Number C: SrrdeTr7-71 <br />ttr <br />o <br />ItrA7 A'P?()t1 TRC:. , Trt«viii x+:r a tear:..' <br />7. Tronsporfer 2 Campany Nome 8, US EPA ID Number <br />t�se Q <br />rte <br />4. a <br />9. Designated FoclliYy Nome aril $JM Address----�--�r�-� <br />10. US EPA ID Number Skit as dYi l�1^ <br />n <br />t.' f I r.er �tcc-yr l I r>ttl, T-rr f r. tis ,( I r u <br />1.i3U Mersa 0 :� <br />00 <br />ttwttevbxntf� .y Pte;."":k..`' <br />LL <br />I R1A+.to, (M -1431t) J1-01A1�1 1�le1,fI2 __/ <br />V <br />11. US DOT Descrlpfian (including Proper Shipping None, Hazard Class, and ID Nur•600 12. Containers 3 T ktl 14.+Unit <br />Z <br />a. No. Type Gtiantity -- Nf/vol 1;''Wii.ijff''f t <br />I ti�63lIS t�fMlti�:MIIF I•LAIM!►lf�R frIQOrQr >t a.s. ICOIIt'Azlls c�lsolwill�, ;9►.f�.;.�•,;,,:.'. ;;. <br />G <br />X a l lr! J r T 4 PQ f l !t{tG (r 31 I r INi�A <br />n fl <br />o <br />m <br />N <br />_� .. <br />o <br />q <br />z <br />a' <br />�. dtNe i)estrtpHbsleAlliw6k Cf -W All <br />nL? R.tdatrlllmfiCadiikYYrL�el«'SwtedAYaee <br />4. <br />0 <br />_._,,.�. Wi,... ... .._.:...... _ .. <br />15. Special Handling Intfruefions and Additional Information <br />Q <br />Z <br />SITE "RISS. M51rtMt ELvll•, TRACY, CII 9S30ASNNLb AM61Rl13: PKART P1R[rrA.2d [(Y 1i11Hk:1IC4 POW. !Mop -91? -77Q{ <br />Q <br />16. OENIRATOR'S CI!RTRWAT10N: 14eeby elation that the contents of this consign mr nt are fully and aaurately described above b nro <br />Y Pe" n Pprig nomeandareJossilingl, pot; ad, <br />d baled, and an In all respects in proper condition for karupnrt h <br />morlte , and la by <br />l> <br />p1 <br />ghwoy occyding b ap stable Inbrratior d cnd noei;acl gcwrrFA*t11 regulations. <br />�.i <br />—r <br />C61 <br />If I am o forge quenh peneroter. I cern`. Phot I have o ram in Iact to red,.ce the v unM and taxici <br />1y '7 program P OI y Of waste gerwrCteo to fhn sfegrtt I tare determir td fG be ecaromicoily <br />procurable and that I how selected the practicable method of treatment, slarap0 r r disposal <br />ildend <br />wrreMly avaiksble to me whict minimi=es the p�esav onrl f0ure hreo' to human heollh <br />the environment; OR, if I am a small gUOnfify generate, I have made a goad faith effort b minimize my waste generation and selrct the item wast management metlxtd that L <br />avoilo6le to me Phot I <br />O <br />and can afford. <br />P inted�7yped Name ; q r .7 P c, a 't 4 - Sgnatrr •�—_ Month Da Year <br />y <br />Z <br />1� <br />17 Transporter ! ACknowl t Of Recti t of MaNf101s " <br />4x <br />W <br />N <br />Prinl/d/Typed Name SignaWre .�.�., <br />Mpmh Day Ysor <br />LU <br />n <br />-"�'-- <br />— <br />O <br />R <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />YSignature <br />Printed/Typed Name — <br />Month I, ay Y ear <br />uz <br />rn <br />4 <br />E <br />R <br />_ <br />V <br />19. Discrepancy Indic*on Spate <br />'Z <br />A <br />I <br />1 <br />20. Facility Owner or Operator Grti ' 'on of rectipf of hazardous materlals covered b }his Manifest except at Hold in here 19. <br />T Printed/Typed Name SIQeOtu v ---• --- - MolInlh Day Yeo, <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/991 <br />ICA Q Yellow <br />EPA 1700-22 . GENERATOR RETAINS <br />