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tale of California—Environmental Protection Agency <br /> arm Approved OMB No.2050-0039(Expires 9-30-99) * See Instructions on back of pa� Department of Toxic Subs ances Control <br /> lease print or type. Form designed for use on elue(12-pitch)lypewr Sacramental California <br /> UNIFORM HAZARDOUS ' Generator's US EPA 10 No. Manifest Document No. 2. 11:11:11:311: 1 Information in the shaded areas <br /> is not required by Federal low. <br /> WASTE MANIFEST <br /> of <br /> 3. Generator's Nome and Moiling Address//;j'i�yr'ts$7!.✓:vel C',C' - A. Stator Manifest Document Number <br /> , 15 3 <br /> w;Y1 or <br /> s K�" ,•^'� ems(` i ', ,1„ ,a v B. Stale Geoerotor'a 16 <br /> t <br /> A. Generator's Phonecla;1N' )i <br /> I 5. Transporter 1 Company Name 6. US EPA ID Number C ro <br /> +vss�}ms•y�gqyState TnaPartees <br /> r's ID(Rerve <br /> �+'naa.Y <br /> .�^..HS' u r C L yP C.� 1: 3. � 2 6 ,e D. Tmmsparter's Phone <br /> i t fJa 8. US EPA ID Number <br /> T�ssspy �pppgy @r. aces^ vE. Seale Tetra orter's fD Reserved <br /> P f_) <br /> AL I:IIIJ32M S(. iv s 0 dei. D tf f'. :i 5 rk T q9 C1 F. Transporter'.Phone •RAgi .. <br /> t 9. Designated Facility Name and Site Address 10. US EPA ID Number G. Shut.P..Ihrgs ID <br /> 6.V:L 2'.2ie3.YeRMJJ.t l.aaNxM1 3:'��.°sYi` H. Facility'.phone <br /> 7 f�i Ya. t! ARafRF. V fi tt Ei E3 9 5 3 38 ear-1.5r1r—.w'1m <br /> 11. US OT Description(including Pro r Shipping Name,Hazard Class,and ID Number 12. Containers 13. Total ld. Unit <br /> i sR f� Pt ( 9 Pe sx 8 ) No. Type Quantity Wt/Vol. I. Wase Number <br /> ' ( rwtis! <br /> v <br /> It, . /in^ ,AL i 'r I. <br /> r <br /> E C....J:.?, 3 r I r i/ G'/ 0 EPA/ <br /> " 6. Land ©R�posal e� f nr�-ion Slee <br /> E <br /> R EPA/Other <br /> A <br /> T Saw <br /> O <br /> R EPA/cher <br /> d. <br /> State <br /> EPA/Other <br /> :h.-Addhio..I Deaeripfians For Materials Usual Above K. Handling Cada.for Wastes listed Above <br /> .1b <br /> d <br /> 15 Special Handling Instructions and Additional <br /> •�1,'L:s; <br /> 3 _ <br /> rtfs k 1TCtrr!#� I`i 4R: ( 4JYLt3i1FlG �c e t14 81"L'F:': 3. lid- <br /> WAR <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this conig ment are fully and ocwrotaly described above by proper shipping name and are classified,packed, <br /> marked,and labeled,and are in all respach in proper condition for transport by highway according to applicable international and national government regulations. <br /> j <br /> If I am o large quantity generator,1 certiy that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economiasllyy <br /> practicable and that I hove eelecred the practicable method o treatment,storage,or disposal currently available to me which minimizes the present and furore threat as human heahh <br /> and the environment;OR,if I am a small quantity generator,I have made a good faith effort he minimize my waste generation and select the best waste management method that is <br /> available to me sad that I can afield. <br /> ngbd/Tywnt Dy d Name SignvNre <br /> f )pe ,Yea[. <br /> :r i ,'" '.,...s,.; 9 i i i i 1 1 1 1 .�I: ( •• 1 ...fJ 6 t 1'•.t it '•. b.... <br /> N17. Trans rter'l AAm.wled ement of Recei t of Materials <br /> 0 Printed/Ty o ,JJName �{7l�'F� ^"� SignatuypK?`" ' Mmlb•,�••• ay/ Y—,' <br /> ^' /.' viY' '•sf"Jafv <br /> 0 18.Trane oder 2 Acknowled amanl aF Receipt of Materials L•/ <br /> 0. Premed/Typed Name Signatureg " <br /> TMonth Day Year <br /> E ' <br /> 0. <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 <br /> k <br /> 20- Facility Owner or Operator Certification of recaps of hazardous materials covered by this manifest except as noted in Ilam 19. <br /> T Printed/Typed Nome Signmure Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> a <br /> TSC 8022A(1/99) <br /> PA 87OD-22 Yellow: GENERATOR RETAINS 1�1 <br /> F <br />