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State of California—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9-30-99) <br />'"se print or type. Form designed for use on elite (12 -pitch) iter. <br />O <br />tn <br />N <br />to <br />00 <br />O <br />O <br />_jop <br />0— <br />C) < <br />J <br />Oa <br />V <br />DZ <br />Dine <br />T2 <br />va <br />V <br />Z <br />3 <br />N <br />O <br />00 <br />ca <br />V <br />N <br />V <br />ccO <br />O <br />a <br />V <br />C <br />} <br />L <br />2 <br />LL <br />or <br />LL <br />LL <br />LL <br />LL <br />C <br />v <br />a <br />L <br />r <br />C <br />See Instructions on back of le 6. Department of Toxic Substances Control <br />Sacramento, California <br />AL.UNIFORM <br />HAZARDOUS <br />1. Generator's US EPA ID No. Manifest Document No. <br />Page 1 <br />Information in the shaded areas <br />:2. <br />s not required by Federal law. <br />WASTE MANIFEST <br />of <br />3. Generator's Name and Mailing Address - <br />r" �7 <br />A: State ManifesID ocume NuT. <br />mber'214067 <br />Toys -R -Us <br />4.4 Q 6 (? <br />1624 Army Ct. <br />B. State Generator's 1D <br />CJt"Jai,_r PBhorte *', 9 5 a 0 6 <br />_ <br />5. Transporter 1 Company ame 6. US EPA ID Number <br />C. State Transporter's ID [Reserved] <br />D. Transporter's Phone <br />lie <br />7. transporter ompany ame -`8. A umber ` <br />E. State Transporter's tD[Reser4e .)" 0 429-2469 <br />coww <br />�' <br />F Transporler's Phone46 <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />CROSBY-OVERTON <br />I 0A b 01 20LI <br />1630 <br />1630 West 17th St. <br />H'. Facility's Phone - <br />1 ontainers <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />No. <br />R <br />13. Total nit <br />Type Quantity Wt/Vol 11 Waste Number', <br />/ / <br />a. w A S 7''e !' !/7T'W1M q blf'//�PU/D/ lads C PA t.t./ <br />State <br />*S, <br />*7 2r(14 <br />D O l <br />D M <br />EPA/Otherz� <br />// fit/'/¢ s.(. <br />State /✓ <br />E <br />R <br />7/ <br />EPA/Other <br />TC. <br />State <br />O <br />EPA/Other <br />R <br />d. <br />State <br />EPA/Other <br />I <br />� <br />J. Additional Descriptions for Materials Listed Above„w aC 1 yal <br />K, Handling Codes for Wastes <br />Listed Above <br />15.. Special Handling Instructions and Additional Information <br />Qom+ Q fir. p� <br />/- s. B !><% S ` Q a .O' •� P C <br />fC <br />Eme r e- r� te o,- d�,f <br />/ <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, and are in all respects in proper condition for transport by highway according to applicable international <br />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 />treatment, disposal currently available to me which minimizes the present and future threat to human health <br />practicable and that I have selected the practicable method of storage, or <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 />Pri to Ty d Name �A <br />Sig{nat�ure-- <br />Month Day Year <br />/l. �. /✓L 6ex e <br />O <br />T <br />17. Trans orter 1 cknowleclement of Receipt of Materials <br />R <br />I <br />S <br />Pri /Typed <br />Signature <br />_ <br />/Month Day Year <br />P <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />R <br />T <br />E <br />Pr pt d/T ped Name <br />% <br />Signature <br />Month Da Year <br />Y <br />R <br />/ j' <br />9 iscrepancy In cation Space <br />F <br />A <br />C <br />l <br />L <br />f <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br />T <br />Y <br />P '"d/Typed Name �p <br />osr. /\ , S M t4--&0 <br />Signatur <br />Month Day Year <br />-5 ?1 0 <br />DO NOT WRITE BELOW THIS LINE. <br />White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />DTSC 8022A (1/99) To: P.O. Box 3000, Sacramento, CA 95812 <br />EPA 8700-22 <br />