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r. <br />Jul '02 06 01:42p TTS Environmental <br />Stale of California—Environmentof Presection Agency <br />Form Approved OMB No. 2060-0039IExpire5 9.30.991 <br />Please print or type. Form designed for use on elite (r2 -pitch) 4r _..ribr. <br />O <br />W) <br />sit <br />n <br />N <br />to <br />m <br />0 <br />O <br />m <br />of <br />W <br />Z <br />W <br />U <br />N <br />Z <br />O <br />n. <br />J <br />a <br />Z <br />O <br />Q <br />Z <br />W <br />r <br />Q <br />U <br />J <br />a- <br />Oc <br />O <br />} <br />U <br />Z <br />LULU <br />0 <br />W <br />Q <br />U <br />ri <br />7074218887 p.4 <br />See Instructions on back of 1 6. Deoarlment al Toxic Subtleness C mtrol <br />Sat ramealo, California <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A 11199) :21 7.: <br />EPA 8700-22 <br />1. Generolor's US EPA ID No. Manifest Document No. <br />2. Page 1 <br />Information i i the shaded areas <br />UNIFORM HAZARDOUS <br />is cot required by Federel low. <br />WASTE MANIFEST <br />G y 'r <br />of <br />3. Generators Name and Mailing Address <br />i A. SioleManflea Documenl Number <br />r !S` -(Z- US <br />I6iq R+r04 cT , <br />B. Slats Generators ID <br />9fo C.ul:a- Cis gSLo d <br />i 4_ Generalor's Phone ( ) <br />i <br />5. Transporter I Company Name 6. US EPA ID Number <br />C. Stose Transporter's ID lReseryed.) <br />Q <br />D. Transporters Phone <br />! <br />7. Tronsporter 2 Company Name - 8. US EPA rD(Nurrlsw <br />E. Slate Transporters ID Reserved.! <br />_ <br />F. Transporter's Phone .. - <br />t. <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. Sate FooliVs ID <br />I <br />H. Facility's Phone <br />1 ? . US DOT Desviplion (including Proper Shipping Name, Hazard Class, and ID Numbarf <br />12. Contoiners <br />13. Total <br />Quantity <br />IA, Unil <br />WI/Vo) <br />1 Weise Number <br />No <br />lype <br />o. <br />X52 <br />t PA/Other <br />G <br />r' <br />E <br />b <br />gale <br />N <br />IPA/Othor <br />E <br />R <br />A <br />! late <br />T <br />c <br />E PA/Olhu <br />O <br />d. <br />Mole <br />I <br />IE PA/Olher <br />J. Addiliortol Descriptions for Materials Listed Above <br />X. Handling Codes for Wastes Lived Above <br />a. b. <br />c. <br />J. <br />IS. Spacial Handling Inslruuions and Additional Information <br />16_ GENERATOR'S CERTIFICATION: I hereby declare the: the contents of this consirh nt are fully and accurarelf described above by proper shipping name and are ebrstiried, pocked, <br />in for transport highway according so app{rrn6le inlernatlonal and national povornenonl regulofi ens. <br />marked, and labeled, and are in all respects proper condition y <br />If I am a large qua(diry generator, I certify I)wl I have a program in piece to reduce the volume and toxicity of waste generated to the degree I hove deteratinel to be economical! <br />have the of treatment, tsworge, or disposal curtandy awildale to me which minimizes the pressrs and hEun rh•aal to hd+mon health <br />practicable and t6a, I aelaclad ppracticofale method <br />and the errviranment, OR, if I am a srnoR quantity generator, I have mode o good faith effort to minimize my waste generation and soled the best waste monagneent method that is <br />ct—ifable to me end Thal I can afford. <br />Printed/Typed Noma <br />Signature. <br />Month Day Yeas <br />T <br />17, Tions orlon 1 Acknowled ern—t of Receipt of Moleriols <br />Man Mt Dy Yeo <br />I <br />Prinkd%Typed Nome Signature <br />' <br />I <br />R5 <br />�1� <br />P <br />B <br />18. Titans orlon 2 Acfmowicd amen! of Recti t'of Maleri cls <br />_ <br />R <br />Prind/Typed Signature :' <br />te <br />Month fay Ysor <br />T <br />.Name <br />19. Disaeputry Indication Space <br />F <br />A <br />C <br />I <br />L <br />20. FacilityOwner or Operator Certification of receipt of hazardous materials covered 6 tale manifest ez <br />t as, noted in Item 19. <br />I I <br />Printed/Typed Noma Signature <br />kbnlh Day Year <br />Y <br />1 I I - <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A 11199) :21 7.: <br />EPA 8700-22 <br />