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c <br />u <br />C <br />C <br />C <br />0 <br />L <br />i <br />3 <br />C <br />a <br />a <br />s <br />C, <br />c <br />C <br />a <br />LL <br />F- <br />2 <br />LLL <br />v <br />2 <br />C <br />LL <br />4 <br />Z <br />C <br />H <br />Q <br />z <br />LL <br />F <br />a <br />a <br />v; <br />ae <br />C <br />} <br />C: <br />Z <br />LL <br />LL <br />LL <br />LL <br />LL <br />0 <br />LU <br />Q <br />V <br />ii <br />State c' 7 'lifornia—Environmental Protection Agency <br />Forrn?4d, wed OMB No. 2050-0039 (Expires 9.30-99) See Instructions on back oe 6. <br />Please print or type. Form designed for use on elite (12 -pitch) t r writer. 9 Department of Toxic Substances Control <br />�J DO NOT WRITE ELOW TH�AINE. v <br />DTSC 8022A (1/99) White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS, <br />EPA 8700-22 To: P.O. Box 3000, Sacramento, CA 95812 <br />UNIFORM HAZARDOUS <br />1. Generator's US EPA ID No. <br />Manifest Document No. <br />2. Page 1 <br />Information in the shaded areasV <br />WASTE MANIFEST <br />is not required by Federal law. <br />of <br />3. Generator's Name and Mailing Address <br />A. State Manifest Docum t Number <br />To s -R -us <br />247'8001 <br />1624 Army ct . <br />B. State Generator's ID <br />> <br />StQn.PhaQz� 952P6 <br />465 4942 <br />5. Transporter 1 Company ame 6. US EPA ID Number <br />C. State Transporters ID [Reserved ] <br />t <br />D. Transporter's Phone <br />i <br />anspor er ompany ame B.' OVEIPAID Wumter <br />E State Transporter's ID [Reserve . <br />I <br />_ W[� Iq I SI&O <br />L3 () 1 ! <br />F. Transporter's Phone �r^� a Z - <br />J <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State. cility's ID <br />CROSBY-OVERTON <br />1630 West 17th St. <br />H. Facility'sPhane <br />1QNG BEACH, CA 90813 <br />11. US DOT Description (including Proper Shipping Name, Hozurd Class, and ID Number) <br />ontainers <br />13.13. T 2 nit <br />No. <br />Type Quantity Wt/Vol I. Waste Number <br />a. <br />Non-Rcra Hazardous Waste Solid (YS39� <br />State_, <br />Z) ERG#171 <br />EPA4010d Z <br />G <br />E <br />14 <br />N <br />bD <br />State <br />E <br />EPA/Other <br />R <br />A <br />T <br />a <br />;stat® <br />O <br />EPA/Other <br />R <br />d. <br />State <br />EPA/Other' <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes for Wastes Listed Above <br />b. <br />-- d <br />CT <br />15. Special Handling Instructions and Additional Information <br />Emergency Response # 786-7645 (Fremouw Enviornmental) <br />16. GENERATOR'S CERTIFICATION: 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, in in for by highway <br />and are all respects proper condition transport <br />according to applicable international and national government regulations. <br />If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br />practicable and that I have selected the �racticable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health <br />and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br />available to me and that I can afford. <br />Printed/Ty Name <br />Signature <br />Month Day Year <br />Trans orter 1 Acknowleciclement of Receipt of Materials <br />A <br />P ' ed/Typed Name Signa <br />^' Month Day Year <br />N <br />S <br />�. a 101 Q <br />P <br />018. <br />Transporter 2 Acknowledgement of Recei aterials <br />RPrintG <br />T <br />Ty ed Name <br />Signature <br />g <br />onth Day Year <br />E <br />R <br />Disc epan y Indication Space <br />F <br />A <br />C <br />I <br />L <br />[ <br />20. Facility Owner or Operator Certification of receipt of hazardous materials cover Is <br />ifest exce t as noted in Item 19. <br />T <br />Y <br />Printed/Typed Name1/ <br />�E <br />Sig ure <br />Month Day Year <br />lq✓ lsf r �,;;, - <br />7-0 <br />I 101 1 <br />�J DO NOT WRITE ELOW TH�AINE. v <br />DTSC 8022A (1/99) White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS, <br />EPA 8700-22 To: P.O. Box 3000, Sacramento, CA 95812 <br />