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State of CaliFornia—Environmental Protection Agency
<br />OMB No..2050-0039 (rxpi,es 9-30-yq.�), See Instructions on back e 6.
<br />type. Form designed for use co elite �-p r. Department of Toxic Substances Control
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<br />DO NOT WRITE BELOW THIS LINE.
<br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS.
<br />DTSC 8022A (1/991 (Generators who submit hazardous waste for transport out-o(-sta 1`61
<br />EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 claysj
<br />UNIFORMHAZA . RDOUS
<br />1. Generator's US EPA 0 No. Manifest Document No
<br />2. Page 1-1
<br />information in the shaded areas
<br />WASTE . MANIFES . T
<br />A D 0 0 9 1 8 9 0 6 91 6 G 41 - 3 ; 3.
<br />31
<br />is not required by Federal law.
<br />1
<br />Of
<br />Geqeiato d Mailing Address
<br />, a's ame an
<br />-lupi �e Aerospace Structu
<br />A. Slate Manifest
<br />t Document Number
<br />4 4
<br />P.O. Box 6169
<br />1
<br />Stockton, CA 95206
<br />B. State Generator's ID
<br />1.
<br />A. Generator's Phone At t T+ Lon K! a0a wd
<br />I fil I A -I F-"LF.713161 01 E, 1 -3 F, L4121
<br />5. Transporter I Company Name
<br />General Evi " 6, US EPA ID Number
<br />nron1Iental mqutt
<br />C. State Transporter's 10 [Reserve
<br />Inc.
<br />D. Transporter's Phone
<br />600-326-1011
<br />7 Tronsporier 2 Company Name 6. US EPA ID Number
<br />E. State Transporter's ID ]Reserved.}
<br />F. Tronspo0er's Phone
<br />9. Designated Facility Name and Site Address 10. US EPA ID Number
<br />G Rancho Cordova, LU(-
<br />G. State Facility's 10
<br />11355 Mlite POCk IROad
<br />93 6, 3 51 0980
<br />Rancho Cordova, CA 95"i'42 8 fi 4 '1 13 13
<br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
<br />12. Containers
<br />13. Total
<br />4 unit
<br />No.
<br />Type
<br />Quantity
<br />Wt/Vol
<br />L Waste Number
<br />a.
<br />Waste Aerosols, f I ajr6T.a. h- 1 e , ((-ach not exceeclIng
<br />Stute, :3v1
<br />G
<br />1 1, CaprAcity) , 2.1, ON1,950
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<br />0. 0 '7
<br />T-�'
<br />EPA/Other
<br />E
<br />�m
<br />D001
<br />N
<br />Rd, WaHte Flammable I iqixids, T) . 0 . 9 3, UN 1.593,
<br />—L
<br />Stale
<br />-331
<br />III (Epoxy & Faints)
<br />L1 0
<br />4 S7
<br />EPA/ORther
<br />A
<br />I
<br />r I I
<br />11001
<br />T
<br />R1d1 W�a$teu F---Aint rela-ed metterial, 3,(UN1.263, 11 1
<br />State
<br />0
<br />R
<br />01
<br />P
<br />343
<br />EPA/Other
<br />11A.
<br />Ik 1-7
<br />D035
<br />d.
<br />RQ, Waste Flaodriable Solida, )).-ganic, n . o . S
<br />"O'e
<br />315
<br />4.1, UN1325, 11 Methyl EthY41 Ketonp,";,C, one) 00 4
<br />L
<br />1- EEPA/O�hd,
<br />Aas th"
<br />10
<br />D001
<br />J. I Additional Descriptions For Materials Listed Above
<br />il.a. R6737 permits for, and will axe
<br />ling
<br />K.anodes For Wastes
<br />Listed Above
<br />b.
<br />Pt
<br />A(
<br />I
<br />the waste this genercatpp,
<br />lj..C. 86730 D001,F003,V065
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<br />7L
<br />ERG: 128
<br />11.d. R1918 D035, FOCI 3, V005 ERG.' 133 shipping
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<br />15. Special Handling Instructions and Additional information
<br />FaiarqeTicy Phone; Intcotrac. 600.535.5053 81te Add:34-
<br />'47 So, Airport
<br />WDO 11312608 Stockton, CA 9520,
<br />I& GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment ore Fully and accuralePy described above by prop shipping name and are classified, packed,
<br />marked, and labeled, and are in all respects in proper condition For transport by highway occord[ng to applicable international and national government regulations.
<br />or 5)pr
<br />Ifa argequan . generator, t certify that I I, program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically
<br />I am I Acge
<br />I
<br />practicable a hot I selected the practicablemethoda treatment, storage, or disposal currently available to me which minimizes tka,present and Futvre 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 generation and-sefict the best waste management method that is
<br />available to me and that I can afford.
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<br />Pri ted/Typed Nam
<br />Signature
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<br />Month Day Year
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<br />5
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<br />17, Transporter 1 Acknowledgement of Receipt of Materials
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<br />Printed/Typed d N nature
<br />Month Day Year
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<br />018.
<br />Transporter 2 Acknowledgement f Receipt of Materials
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<br />I
<br />Printed/Typed Name
<br />Month
<br />M711 Day Year
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<br />19. Discrepancy Indication Space
<br />IF
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<br />— 0. Facility Owner or Operas %fFertificortion of receipt of hazardous materials covered this manifest except as ted in Item 10.
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<br />Printed/Typed Name J
<br />Sign6 -F
<br />p!�.r
<br />lit
<br />Month Day Year
<br />Ljf L -11.0
<br />DO NOT WRITE BELOW THIS LINE.
<br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS.
<br />DTSC 8022A (1/991 (Generators who submit hazardous waste for transport out-o(-sta 1`61
<br />EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 claysj
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