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, —Environmental Protection Agency
<br /> OMB No.2050-D039(Expires 9-30-99) See Instructions on back a X90 b. Department Subsm,ni.Control
<br /> ,ydr type. form designed for use on efin(I2-pikIk"writer. r ✓ Saaamesha California
<br /> UNIFORM HAZARDOUS C ....br's US EPA ID No. % Manifest Document No. 2. Page I formation in the shaded areas
<br /> is not required by Federal law.
<br /> WASTE MANIFEST ne iAiwono 3 ,1 ,jii zof I
<br /> 3. General.!,Noma and Mailing Address A. State Manifest Document Number
<br /> _ Mt?:h'CU 1.-1113Ek fyY�il7:r:M4i
<br /> 24317344
<br /> 0 1'.O. DOX4O . Sl Ul'KJ'C.NJ, (:A. !XQ01l B. Stare Generator's ID
<br /> h d. G...raroK, Phone f M91-446 4011 Atrl: I"OM i3Aki.YV(4
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<br /> N 5. Transporter 1 Company Nama 6. US EPA ID Number C. Slate Transporter',ID fRoserved.1
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<br /> m m' 1.. '�, ,nil Q .0 ,,k Ra }J D. Tran,port.r,,Phone �.�� .F d y, .'jf 4 f
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<br /> cp 7. Transporter 2 Company Name - 8. US EPA ID Number E. Slate TranaporteK,ID IReserved.]
<br /> F. Tronsporrer's Phone
<br /> U G. Stale Facility's ID
<br /> 9. Designated Facility Nama red Sita Addru, 10. US EPA ID Number
<br /> flauth;: idrt•.:UL+I'7:e F�eauvely
<br /> z3 '01 . Pit, ) ,iVl1I$ H. Facility's Phone
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<br /> � ►�-d �atl4 ]O Ga. fXWOFi
<br /> 'V Q12. Containers 13. Total ld. Unit
<br /> U 11. US DOT Deuriplion(including Proper Shipping Name,Hazard Class,and ID Numborl No I Type Quantity WI/Vol 1 I. Waste Number
<br /> Z . Sore 331
<br /> Waste Flammable H 'd, N.O.Q., :1 UNI993, 111
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<br /> t C*0I f: 1\(V 1 20 EEPA/Olh.,::�_
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<br /> v A State
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<br /> W O EPA/Other
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<br /> w EPA/Olher
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<br /> J. Addittancl Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above
<br /> t�« Y7- `��?r 1/-1 -7,
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<br /> s c. d.
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<br /> Z 15. Special Handling Instructions and Additional Information
<br /> Han attar',; shUGM ble 110 hcrur irau',ed ;u Irl +.eek ai/lJr creed 1:{y,
<br /> Z V rtsr r.•1TC:'ti Phone:r1( d1031311-Ci"/41 !tits M
<br /> Ib. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurolely described above by proper shipring name and are classified,packed,
<br /> Umarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and notion government regulations.
<br /> If Iam a large quantity generator,I certify that I have a p ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economico%
<br /> a practicable and that I hhave selected the practicable method of treatment,storage,at disposal currently available to me which minimizes the present and future threat to human heallh
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<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 /> 0 ava4a61e to me'ond that I can afford.
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<br /> Pri Name Signature 7t'� Month Day
<br /> Z f 3I ti`dL� F t'
<br /> W 1 17. Tr r cknowled ecei 1 Maleriols
<br /> w j rinta�/Ty Nams s 8i /' Month__ Day- Year
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<br /> 4 } J vnv 71 Z-
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<br /> W 0 18. Trans iter 2 Acknowledgement of Receipt of Materials
<br /> 0 1 Printed/Typed Name Signature Month Day Year
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<br /> 19. Discrepancy Indication Space
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<br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this monilest except as noted in Item 19.
<br /> T Printed/Typed Nome Signature Month Day Year
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<br /> DO NOT WRITE BELOW THIS LINE.
<br /> DTSC 8022A(1/99) Ye11.- GENERA-O, 4ET'
<br /> EPA 8700-22
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