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<br /> 400391Evpi es 9-30-9+� , .SBC Instructions ell kms, "of
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<br /> Sacramento,California
<br /> r ORM HAZARDOUS 1. C' rvlor's US EPA ID No. Moni(n1 Document No. 2, page I Inrortn.hea in d.fhaded areas
<br /> -WASTE MANIFEST , qty of I is not r99'�yfederal Is,
<br /> reraror s Name and Mailg�Ad�dre S V A State Manifest Document Number ry,E - —
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<br /> ,0is .N.,a r r 8 State Generator's ID
<br /> A. Generator', Phone ,/-bT/�^„
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<br /> 5. Transporter I CCoompyoryyNNaa Name 6. U5 EPA ID Number C. Stole Tronsporler's IDlReserved.]Its I& -
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<br /> 7. TronsporM 2 Company Name 8. US EPA ID Number E State Lansp 1 ID]Reeerved.]
<br /> V 9. Designated FaciBty Name and Site Address �1�0. U.SrE!PA ID Number G St t F ilny's ID - ---
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<br /> i11. US DOT Desert on(including Proper Shipping Nam , Class,and ID Number) 12. ConMiners13. Total 14. Unit
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<br /> ZJ; Add'Y I D -IpGo s for{Mater els L Bred Above t ax,., 'x'4!1 0 ., - v " ''K Hpndlmg Codes(oF Whites Listed Above
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<br /> O 15. Spey of Handlln,lnws,t ms and Add'1.o.a1 I.fo,aI -
<br /> a 14 Hour Ernelgency Response Tel,No.CHEKNIC WM 444-93110
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<br /> Sales Order# rS
<br /> Q16, GENERATOR'S CERTIFICATION: I hereby dedvre that d»contents of this consignment are Fully and accembly described above by proper shipping name vml an classified,packed,
<br /> U marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national govemment regulations.
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<br /> ge q generator,I carli that I have a rooggram in lace to reduce the volume and toxicity of waste generated to The degree I have determined to be ecmamical�lY
<br /> ydj practicable and dfat I have selecled the practicable method of treatment,storage,or disposal currently available tome which minimizes clue present and Iutere threat to human h.aNh
<br /> ac and the.nvironment;OR,if I am a small quenfity generator,I have ma e a faith effort to minimize my waste generotian and select dm best wash management t human dal is
<br /> available to me and that I can afford. �'.s f-;
<br /> V Pr' typed Noma ig. toe _ * -
<br /> Day Year
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<br /> (wfj M 17, rams rl Ackrwwl toFRxsi for Materials
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<br /> LL 18 Try rte Acknowledgement of Receipt of Materials
<br /> E rated/Typed Name Signal.. M10"A Year
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<br /> 19. Discrepancy Indication Space
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<br /> f1.20. reca Avner. or ORIMPor Certification of reallint of hazardous materials covered R,is manifest exc as noted in Item 19.
<br /> T rnmea/Type t Name SignaNre
<br /> Y Mond Day Year
<br /> DO NOT WRITE BELOW THIS LINE.
<br /> DTSC 8022A(1/99) Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS.
<br /> EPA 8700-22 To: P.O. Box 400, Sacramento, CA 95812-0400
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