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State of California—Environmental Protection Agency <br />Form Approved OMB No.,1050-0039 [Expires 9-30-991 See Instructions on back ate 6. Department of Toxic Substances Control <br />Form designed for use on elite ( 12-pilehwfer. Sacramento, California <br />0 <br />40 <br />CV <br />to <br />CC) <br />C14 <br />0 <br />00 <br />w19 <br />C14 <br />6 <br />00 <br />tY <br />0 <br />14.1 <br />V) <br />U <br />K <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) Yellow: GENERATOR RETAINS <br />EPA 8700-22 <br />UNIFORM HAZARDOUS <br />I Generator's US EPA ID No. Manifest Document l' �o <br />2. Page I <br />Information in the shaded areas <br />is not required by Federal low. <br />WASTE MANIFEST <br />�j ;1 1:1 q 0I ,-I -..I .-j .-j ;�j r-joa�l LI <br />of <br />3,.Generators Name and Mailing Address <br />A. State Manifest Document Number <br />2 4 4 1 06" 0' 3 <br />S. State Generator's ID <br />4, Generator's Phone-Al'1-, -1. :j -3 j,; A 1: !1V <br />k 1(1311- . <br />5. Transporter I Company Name 6, US EPA ID Number <br />C. Slate Transporter's ID [Reserved.] <br />D. Transporter's Phone <br />10 3- 1 <br />7. Transporter 2 Company Name B. US EPA ID Number <br />E. State Transporter's ID (Reserved.] <br />I I I I I I 1 <br />F. Transporter's Phone <br />9. DenjatV Faci% Name and Site Address 10. US EPA ID Number <br />817v� Ili:) <br />G. Stale Facility's ID <br />1. L 1; f. �Vhi f- Ro <br />H. Facifily's Phone <br />P,�rachc L) <br />1. 6 351 G <br />11. US DOT Description (including Proper Skipping Name, Hazard Class, and ID Number) <br />12. Containers <br />11 Total <br />14. Unit <br />No. <br />Type <br />Quantity <br />Wt/Vol <br />I. Waste Number <br />IL e ,vi Iota Ie. {c=; CJ i:: :1 L.:. :):-:11�-.'Ji <br />State <br />c; a 4c::t L <br />0 <br />EPA/Other <br />E <br />N <br />Q, IX a :S t: F3 F I an,. 3 na b-1 P L 1 ij41 A d S rd i , r <br />State <br />E <br />Ro <br />1 17 f <br />0 <br />A <br />Ila 1(d, <br />1 <br />T <br />e.4, <br />State i <br />0 <br />EPA/Other <br />R <br />1 <br />WA!5te Flaimlabit'i T;.ci-4:., UH1993, 11 <br />Slate <br />EPA/Other k-! <br />J. Additional Descriptions For Materials Listed Above <br />K. Handling Codes For Wastes Listed Above <br />1 'R C, <br />I .. I i'-� 'k 1 . '. TR <br />a. b <br />i" 3Et <br />c <br />d <br />15.S$b dial, 4n A; <br />G -t 1 3, Wl" <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described alo ova by proper shipping name and are classified, pocked, <br />l <br />marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br />If I am a large quanti generator, $ certify that I have a program in place to reduce Ike volume and toxicity of waste generated to the degree I have determined to be econo 1 11 <br />l <br />nkave <br />practicable and that I'Kselected the practicable method a treatment, storage, or disposal currently available to me which minimizes the present and Future 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 select the best waste management method that is <br />available to me and that I can afford. <br />Printed/Typed Name <br />no <br />ncif.M% <br />nth Dap Year <br />V <br />Lo" <br />r <br />Tom Ti TV <br />T <br />J-7—Tronseorter I Acknowledgement of Recelpf of Materials S ry <br />R <br />A <br />I Printed/T V.d Name <br />Signature <br />Month Day Year <br />P <br />177 P [S" <br />0 <br />1 If Trans pcirf.,-2 Ackno,(I.d.nn-ert of Recalipt otll�heriols <br />Tis <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />E <br />19. Discrepancy Indication Space <br />IF <br />A <br />C <br />I <br />L <br />1 <br />20. Facility Owner or Operator CertiFicofion of receipt of hazardous materials covered by this manifest except cs noted in Item 19, <br />T <br />Printed/Typed Name <br />Signature <br />Month Dqy Year <br />Y <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) Yellow: GENERATOR RETAINS <br />EPA 8700-22 <br />