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Slate:af California—Environmental Protection Agency Form A Y ved OMB No. 2050-0039 (Expires 9-30-99) See %structions on back of�e b. Department OF Toxic Substances Control se4 in +ot type. Form designed for use on elite (I2-prtch ter. Sacramento, California UNIFORM HAZARDOUS 1 venerator's US EPA ID No, Manifest Document No. 2. Page 1 Information in the �Federal as WASTE MANIFEST is not required by . of 3. Generator's Name and Mailing Address A. $tale Manifest Dacumen` No r� Applied Aerompace Structures, Oarp . C, � �' 3437 3. AIVPOrt Way, P.O. BOX i�3.8 LO t Ckt. q C� 95 � 5 B. Slate Generator's ID 47 4. �Senerator %one A��#. 0 �.,y,,. �. dip s. +V L 7 s"ilP7 5. Transporter 1 Company Name 6. US EPA iD Number C. State Transporter's ID [Reserve ,] D, Transporter's Phone • ♦ + 7. Transporter 2 Company Name - - - - - -8;" US- EPA ID Number E. State Transporter's ID {Reserved. F. Transporter', Phone V 9. Designated Facility Name and Site Address V q g ty 10. US EPA ID Number G. State Facility's ID d P01l.uL�ioll Control induetr;�ie U � 11855 White Rocks Rl oad H. Facility's Phone A Railicho Cordova, CA 95670 1r1A1n191s1o1R1A1.. 11. US DOT Description (including Proper Shipping Nome, Hazard Class, and ID Number 12 Containers 13. Total 14. Unit U P { g P PP g l No. Type Quantity WI/Vol I. Waste Number a. N+an- Hazardous>;>�at.e, Solid (empty drues)5 State E 0 j} J.} P EPA other oCD [V b. Won-RrPjk Bazartious Wc3sta, Solid (eilipty drijals) tl-r State a® E 0t EPA/Other v A f3 to r Q [i 19 r Mone OT c. state w O R EPA/Other LLJac t— d. State Z LU EPA/Other w Jr N J. Additional Desert lions For Materials Fisted Above K. Handling C des for Wastes Listed Above Z al #2569i� *i G.. a. 4�> •� r^e Uj c. d. Z 15. Special Handling Instructions and Additional Information © Wear proper PPE invoice: Premier chemical Z q Hour ergerar^y phone Number. (800) 535-5053 z v Q16. 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, marked, and labeled, and are in all respects in proper condition for transport by highway according to opplicaisle internotianal and notional government regulations. J I 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 f hove determined to be economically v� practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health 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 Cie available waste management method that is available to me and that I can afford. O Printed/Typed Name Si tore ^T Month Day Year W Ur f T 17, Trans anter i Acknowledgement of Receipt of Materials LUR Printed/Typed Name Signature' Month Day Year LU S T /l„ 0 P sL 0 1 S. Transporter 2 Acknowledgement of Receipt of Materials © R Printed/Typed ed Name - t11 E YP Signature Month Day Year cry R a V 19. Discrepancy Indication Space Z F A C L f r I 20. F ' i wner or O orator Certification of re i t of hazgf%us ifs cove d b thi anifest eta6teJ tem 1 T Print{ /'llyp Name Sign ore F, y 7 4l V Month Day Year_ 0-11r- � -� -� A 1v 1 , ADO NOT WRITE BELOW THIS LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS, DTSC 8022A (1/99) (Generators who submit hazardous waste for transport out -of -slate, EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.)