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Stab of Celikryry}}la—Envlrbmnmrol Proteetton Agenry 1 s
<br />Form ApprovedOMB�;lo. 2050-00391Expira 930991 �BB IOSrfUCif 0�1�01' .. Dem n d. i6ubs(�tleais Control
<br />Please print or type. form designed for un on elite (12-pikh) iter. Sacramento, Collfamia
<br />DO NOT WRITE BELOW THIS LINE.
<br />DISC /022A )1/99) - Yollow', GENERATOR RETAINS
<br />EPA 1700-22 t
<br />UNIFORM HAZARDOUS
<br />Generator's US EPA ID No. Monilea DocumM No.
<br />�'N0191011
<br />2. page I
<br />Information In the shaded areas
<br />1s not required by Federal law,
<br />WASTE MANIFEST
<br />of 1
<br />3. General.,', Name and Mailing Address
<br />A, State Monifesl Document Number
<br />j� ey ,tl
<br />A.f.. Sensrsrses W Carr*Wc-
<br />8 r x
<br />4101 At Ailpf"t W.Tf 4IE41IIICir1F1,CA 110/:1116
<br />D State Generntar's iD
<br />A. Generaror's Phone l 71RE IMaF 2CQk9 '•1111'
<br />,,.
<br />5. Treinpodo 1 Company Name d. US IPA ID Number
<br />C. State Troneporlo, s ID.
<br />.ry
<br />115
<br />R�amrEe. ViwfrimtnEn fa J "trtYil'V"• x R 7 .L! •if} Q� O 3
<br />D Tlamponer's Phone 916e asel l S?41
<br />7. Tronspoder 2 Company Name B. US EPA ID Number
<br />E. Slate Tmn,porler's ID [Roso,y. I
<br />I I I I I I I
<br />F TmnsportePs Phone
<br />p. Ian I/ WI 10. US BPA ID Num e� r
<br />Sit, Add....
<br />IR`-eiV i�l�lie1e611
<br />G#fele ae fy s 10
<br />F� R E 2�i
<br />$1RY91,P r�. ;N k2, sE
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<br />11, US DOT Description llncluding Proper Shipping Nome, Hazard Class, and ID Number)
<br />12. Containers
<br />13. TaMI
<br />Ouantl
<br />IA. Unit
<br />Wt/Vol
<br />I, Waste Number
<br />No.
<br />T e
<br />Noif 14CRA I lanrdolln i %wit, ;'-All (I nf•! til,,;)
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<br />EPA/elites,
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<br />Seale
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<br />EPA/Other
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<br />Sloth
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<br />EPA/Other
<br />d.
<br />Stab
<br />EPA/Other
<br />J. Arfduilionol Descriptions for Materials Uebd Abovs .d
<br />K. Handling Code, for Wmtas
<br />Listed Above
<br />6.
<br />,
<br />A
<br />c.
<br />d.
<br />r+ 1
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<br />15. Special Handling Instructions and Additional Information
<br />I I :,i Ilitait'::htp d;t f t,:, lfll !'� �, .F fralrwld Fxtd tl5d ��3r3rryo�+d ppe
<br />_.FT)f!fFJE?IT('V pt)ollfa Will t, I..,1i.{: Jolt ✓..= ''rf}T{It ,M
<br />t4tPil 'i"p"It uv. -r, car. lei .,,. t A Lire i t ll.
<br />id, GENERATOR'S CERTIFICATION: I hereby declare that the contents of this eonslQnmtnloro fully and eaeumtely dfwdbed above by proper ship Ing name and are classified, packed,
<br />marked, and labeled, and are In all respecD In proper condition for Iransperl by highway according toopplleahIs International and natlene government regulations,
<br />If I am a large q.onligenerator, I certify that I hove o program in place b reduce the �Ibmeypd toxicity of waste generated b the degree I have determined b be economical),
<br />practicable and that I have selected the practicable method of treatment, storage, oyg�spome se
<br />l currently mailable to me which minimizes the present and Future threat to human hsahh
<br />I have
<br />and the environment; OR, if am a smaquantity generator, I made a good7aith effort to minimise my waste generation and select the best waste management method that is
<br />available to me and that I can afford. i 1
<br />Printed/Typed Name _
<br />Slgne , : s
<br />Month Day Year
<br />)el
<br />1g
<br />17. Trans e"OullifofM ials
<br />Prinled/Typed
<br />Sig..Itm
<br />Mond, Day Year
<br />t rte-
<br />_
<br />IS. Transporter 2 Acknowledgement of Recd t of Materials .w
<br />Printed/Typed Name
<br />Signmwe _
<br />Month Da Year
<br />19. Discrepancy Indication Space
<br />F
<br />A
<br />C
<br />20. FaClli Ownor or Operator Certification of recd 1 of hoxardoe material
<br />covered h this manifest except as noted in Item 19.
<br />T
<br />Prinhed/Typed Name
<br />Signalure
<br />Month Day Year
<br />Y111111
<br />DO NOT WRITE BELOW THIS LINE.
<br />DISC /022A )1/99) - Yollow', GENERATOR RETAINS
<br />EPA 1700-22 t
<br />
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