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State of California—Environmental Protection Agency <br />Fenn Appr6yed OMB No. 2050-0039 (Expires 9-30-99) See Instructions on back of -qge b. Department of Toxic Substances Control <br />Please print or type. Form designed for use on elite (12 -pitch) -iter. Sacramento, California <br />C <br />N <br />Ln <br />00 <br />O <br />O <br />� J <br />V <br />t <br />7Z <br />J0 <br />Ja <br />V <br />Z <br />0 <br />CD <br />00 <br />v <br />N <br />.Q <br />O <br />O <br />00 <br />W <br />LU <br />Z <br />LU <br />V <br />LU <br />en <br />0 <br />N <br />LU <br />LieQ <br />Z <br />60 <br />a <br />Z <br />LU <br />J <br />V <br />J <br />a <br />N <br />-J <br />LU <br />V) <br />Q <br />V <br />Z <br />DO NOT WITE BELO THIS <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />LINE. <br />White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />To: P.O. Box 3000, Sacramento, CA 95812 <br />UNIFORM HAZARDOUS <br />1 • nerator's US EPA ID No. Manifest Document N... <br />2. Page 1 <br />Information in the shaded areas <br />WASTE MANIFEST <br />" <br />is not required by Federal low. <br />l �a cf' O <br />7 <br />I of <br />3. Generator's Name and MailingAddress <br />ress <br />A Stp}p fist Nlah; WA 0. et'i Npm�re( n <br />Toys- i'n — V <br />4. Generator's Phone <br />I <br />f <br />S. Transporter 1 Company Name 6. US EPA ID Number <br />C Si6fe Transporter s lb -m <br />- V � <br />T� a C/1dr <br />T? Transporter'; Phone <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E, Statta 1`r9p$�ortor's ID jReserved <br />!' ©�5 7-0Vel /V / `— <br />F. TmnsporTar'rPtione �/� /_` •�r O <br />v Fi <br />9. Designated Fac//ility Name and Site Address 10. US EPA ID Number <br />G. -State Facility`" ID" <br />7 r -7 ! <br />j c <br />M' FaciftFy ss Phape <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />14 Unit <br />No. <br />Tye <br />Quantity <br />Wt/Vol <br />il;: Wast@ NJm�t3r , w <br />a. <br />State « <br />Cv s �� �o �i A o f (t ' <br />® <br />o . <br />P <br />EA�4the> <br />Nb. <br />State <br />E <br />�A�Other <br />R <br />A <br />T <br />C. <br />O <br />N' r <br />Rf?4%o)her <br />d. <br />r s <br />J. Additional D'escription's For Materials Listed Above <br />K; Fian�iltng;Codes f r WCIS e3 <br />Listed A6dJ <br />15. Special Handling Instructions and Additional Information <br />&—Z" e iv'T 1g, 4,v e V ke 5 <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 ore classified, packed, <br />marked, and labeled, and are in all respects in proper condition For transport by highway according to applicable international and notional 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 <br />practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to <br />generated to the degree I have determined to be economically <br />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 <br />generation and select the best waste management method that is <br />available to me and that I can afford. <br />Printed/TName <br />Signature <br />Month Day Year <br />e&,#Ay Moo& e <br />x <br />T <br />17. Transporter 1 'Acknowledgement of Receipt of Materials <br />A <br />PrirodZTyped Name <br />Signature <br />Month Day Year <br />R <br />S <br />P <br />0 <br />18. Trans otter 2 Acknowled ement ofRecei t aterials <br />TPrinte <br />Typed Name Signature <br />M nth ay ear <br />R <br />/ <br />9 p cy ndic on Space <br />F/7 <br />A <br />C <br />I <br />L <br />1 <br />20. Facility Owner or orator 'Fication of receipt of hazardous teria s ed b this moni t exce t as noted in <br />Item 19. <br />T <br />Printed/Typed Name Signature <br />Montll Da Year <br />Y <br />4� <br />6,1:11 <br />W <br />DO NOT WITE BELO THIS <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />LINE. <br />White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />To: P.O. Box 3000, Sacramento, CA 95812 <br />