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a.®ve v,sb...A... .a alta 14"ATy L <br /> Form Approved OMS No.2050-030(Expirq 4-70-99) S0@ Iflit ructions on back of Rage 6i- pepornr,am of Toxic Substances Control <br /> Pleas print err type. Form designed lar um an owe(l2-pitch( pewrirer. Sacramento,of Toxic <br /> SubstCalifance <br /> rnia <br /> UNIFORM HAZARDOUS US EPA ID No. Manifest Daeumont 2, Pago 1 Information 6 Tho shaded areas <br /> WASTE MANIFEST ": 'l [1 t"� ? 1 1 of 1 it not required by Federal law. <br /> 5 5 <br /> 3. Generator's Name and Moiling Address <br /> MRS. DAN SORELL I <br /> 0 853:111 N. JAt;:k::T0NE: RV. , STOa—"TON, CA 9521 �.-...,.. <br /> in 4. Generator's Phone(�f 1'{I '�,'+��—1�r,�.�, � c'� '• <br /> C4 5..SrrTrransportefr t Crtom,pany Name b. U/SrEPA 10 Num9ber 9 !S!5 <br /> r <br /> t? NOR CAL 0 i� AL' � 7°� � 1� �� JJ yam.+.e,',• r <br /> Q - , 2 G' <br /> -i-Transporter 2 Company Name S, US EPA ID Number <br /> fn lJ 9 <br /> Designated facility Name and Site Address 10. US EPA ID Number e - <br /> v¢ r'."Ya�I Tim O I L I I , I 111. . ' <br /> t a; Ei•lCrI�f' AL ST. <br /> © �-a E i , i,_i-9 r•a J'..t♦-! <br /> '.. <br /> I rYT 8 <br /> U P I 9 PShipping . 12. Ca 13. Total 14. Unit <br /> 1 1. US DOT Description mcludin Proper Name,Hazard Class,and ID Number) 6„RA r <br /> No. Type Quantity Wt/Val <br /> 34?z a. <br /> ".1r11J-4'1 F�F1 H.A7.A R E'QI.lc WAO� TC: L---'QUID <br /> t ATEF's U o 1 <br /> rte„ <br /> 63 'rr <br /> f� E 'fp. <br /> It <br /> Ab <br /> A ;:; . <br /> a*o T ^V ,. <br /> O l'f <br /> R <br /> Uh d. <br /> W r <br /> rr' <br /> Uj <br /> V) <br /> loin Mod <br /> IL <br /> W � :� 'aw• �'•• qr ..f•'1 <br /> Z '�t.�. '.t`..":lr',•''� P"' ..i;".r i 'f..,ler"„GN,�,f '• .. ,4;•t4".9w,•t4 .� <br /> Q 15. Special Handling Instructions and Additional Infeemalion <br /> Ztu <br /> J <br /> I <br /> 16. GENERATOR'S CERTIFKATION. I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> marked,and labeled,and are in all respects in proper condition for transport by highway st"ording to applicable international and notions)government regulations. <br /> If 1 pen o largo quantity generator,I certify that 1 have a pr rem in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economicallyy <br /> Practicable and that 1 have selected the radicable method of treatment,storage,or dispowI currently available to me which minimizes the present and future threat to human haahh <br /> and this environment;OR,if I am o small quantity generator,I have made a goad faith effort to minimize my waste generation and select the best-0116 management method that is <br /> available to mo and that 1 can afford. <br /> 7� Prin / pad N e / Signatur Month Day Year /I <br /> LOOP- <br /> Vt 9 17 Tron rtor I Acknowled enront of Recei t of Molerials V <br /> =U Ii Printed/Typed d Nome <br /> W M YPg , '""� ` Signature "...� ,r Month Day Year <br /> }� <br /> Ill. Tegasoodo, Ac no amen►of Recei t of tvlaleriols <br /> s`syy' T Printed/Typed Name Srgnafvre Month Day Year 1 <br /> U F 19. Discrepancy1nd-kol'on Space <br /> z A <br /> 1 <br /> l <br /> l 20. F cili r or. r C t i If f r ei t of hazardous materials covered by thk ausnilatt exee a noted in Item 19. <br /> T Ni-ted/Typed Name -, 5ignanr — <br /> re "f Month 0 Year <br /> Y <br /> 0O NOT WRITE BELOW THIS UNE. lolz -1.9-12 <br /> DT$C 6022A 14/971 <br /> EPA 8700-22 Ctaen: TRANSPORTER RFTAINS <br />