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State at ColiFcirWa—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9.30-99) See Instructions on back of 6. Deportment of Toxic Substances Control <br />Please print or type. Form designed for use on elite 02 -Fitch) a ter. a 5 .... rr­ta C.46 -Ya <br />0 <br />LO <br />LO <br />IN <br />C? <br />0 <br />0 <br />co <br />0 <br />)0 <br />Z0e: <br />10 Q <br />Q <br />LU <br />V) <br />U <br />Z <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 80222 {1/99) <br />EPA 8700-22 YeJlow: GENERATOR Ri <br />UNIFORM HAZARDOUS <br />1 Generator's US EPA ID No. Manifest Document No. <br />2. Page I <br />Information in the shaded areas <br />WASTE MANIFEST <br />is not required by Federal low. <br />1 It t$19 jr I i� I <br />of <br />3. Generator's 'Name and Moiling Address <br />Applied Ael:-�ftplr�,e <br />A. StaieMonifest Document Number <br />22853856, <br />&3rport- <br />Q'A 95206 <br />B. State Generator's ID <br />4. Generator's Phone 1-1 0 9 ) 9 8- 2 S? <br />It kj #, I � -rt 1te-,-ijo I "-,I iI f�j 1 <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter's ID [Reserve <br />D. Transporter's Phone <br />7. Transporter 2 Company Name 8, US EPA ID Number <br />E. State Transporter's 0 [Re-se,rvod-1 <br />II I <br />F. Transporter's Phone <br />9. Designated Facility Name and Site Address 10L US EPA ID Number <br />G. State Focility's ID <br />r."011trcl . <br />Kermiii Ave <br />H. Facility's Phone <br />Ea!!0 Chxc,2qa, 341 4 —�3,c 11 In li�, p 10 p le 1'4 ji:., I <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 />Type <br />Quantity <br />Wi/Vol <br />L Waste Number <br />ff-ArALIJOUZ 0-3 7, uVa <br />State <br />G <br />01 <br />EPA/Other <br />E <br />os <br />N <br />fi.3i_1 <br />b. rctA= t.tr- 1_1 c1l 1-1 ..2?; . :,m L <br />State <br />E <br />P I <br />EPA/Other <br />R <br />SP <br />A <br />P <br />T <br />C. n . ck !i f uI f n r 7 <br />State <br />0 <br />EOL, <br />Ya <br />R <br />Io 1P 1 14 <br />1.E'ji . 'At' Z j . Ca ... . _,1. 1! ::,1 I. - <br />State <br />:21'.7.[x,A <br />0101013�6, <br />vt-r <br />EPA/Other t <br />J. iAd 1�,ww 1 Muli Lis <br />Q ftris �le Ty -4 0 <br />_L_.. . _.. - <br />K. Handling Codes For Wastes Listed Above <br />y 5 SW X -55 ;)AA C) I -1 5 S OF Y, F <br />J�, $pipipl, cm+ijg lWtiruct� q,* Ajc1ftn.Ljni pi <br />L54 Gji L5 4 <br />f I k -.Ta ;a t Ic.ri <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are f0y <br />y and occurote�y described above proper shipping name and are classified, packed, <br />labeled, <br />marked, and <br />and are in all respects in proper condition for transport by highway according to applica6le international and nationalgovernment regulations. <br />in place <br />If I am 0 large quantity generator, I certify that I have a program . to reduce the volume and toxicity of waste generated to the degree I have determined to be economicalf <br />of <br />practicable and that I have selected the practicable meth treatment, storage, or disposal currently available to me which minimizes the present and future threat to human heold <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/Typed Name <br />month Day Year <br />L O t4 A G; A V,1 A <br />0 <br />y 10 <br />T <br />I <br />17. Transporter I AcknowfedQement of Receipt of Materials <br />I <br />N <br />Fi d/Typed Name <br />rIgnatur. <br />u <br />Month Day Year <br />S <br />P <br />/I <br />IL <br />I <br />18. Transpari Acknowlecleement of Receipt of Materials <br />R <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />E <br />It <br />19. Discrepancy Indication Space <br />IF <br />A <br />C <br />L <br />1I 1 <br />20. Facility Owner or Operator Certification of receii of hazardous materials covered by this manifest except as noted in Item 19. <br />I <br />Printed/Typed Name Signature <br />Month Day Year <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 80222 {1/99) <br />EPA 8700-22 YeJlow: GENERATOR Ri <br />