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State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30 See Instructions on -k of page 6. Department of Toxic Subelanr <br /> Please print or type. Form designed for use on elir ,imh)typewriter. <br /> Sacramento,Calibrn <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No 2. Page 1 Information in the shaded area <br /> is not required b Federal law. <br /> i� <br /> WASTE MANIFEST ( 010 17 of ! EM <br /> y <br /> 3. <br /> O Generao✓a Kom.a!l nd ln A A. Stale Manifest Document Number <br /> 217509 5VV <br /> B. Stat.Generalafs ID <br /> N 5. Transporter 1 Company Name 6. US EP ID Number C. State Trumpormfs ID rRe,.rved.I <br /> h <br /> sj $ ® D. Transporter's Phone1A 10 It It 12 14 11 13 1 <br /> aD 141 <br /> 7. Transporter 2 Company Name B. US EPA ID Number C E. Slate Tmnsporre/s ID Reserved.( <br /> i �Q F. Transporter',Phone <br /> U Q. Designated Facility Name and Site Address 10. US EPA ID Number ,,i G. State Pn6llitys.Rto q <br /> �Q !e"El-rCDZ , f:.1s�P' i'114:;X Z S i:-A s30. +4r I-L`'^' It I! Y H 6 1419 141311161 <br /> Wad 142.1 ftvw R014. H. Facility's Phone <br /> liee..2: SuJoKCAVA131 It 1A ID 18 1 1914121116 1-04U-M <br /> Q I. US DOT <br /> A�+U Desai fon cluding Proper Shipping Name,Hazard Class,and ID Number) N20.CnTerse 13. Total 14. Unit <br /> Ouontiy WI/Vol I. Waste Number <br /> NZ a Slate pqp <br /> 140Et 1 fazardbcm w4cte,Stllid LN <br /> 3 E 'X L>4 SIDL E <br /> o N b' - State <br /> co E <br /> `P R EPA/Other <br /> C`1 A <br /> o T stere <br /> O <br /> R EPA/011ier <br /> n <br /> Zd' Brom <br /> Z <br /> W <br /> U EPA/Other <br /> w <br /> J. Additional Descriptions for Moterials Listed Above <br /> OK. Handling Codes for Wastes Lists Abave. <br /> 6 <br /> a. b. <br /> H <br /> W <br /> MMi�Md6lN�llFC. d. <br /> a m <br /> ZO 15. Special Handling Instructions and Additional Information <br /> Z � P4t1aRfFFiaer�sl '�i.ka.{7#1'9tf�i-Soli-x'1.9-93it� <br /> W MIT a171 wtp.r PateNO CIONag sm of i ctdiF,Q <br /> Sates Cli rder# <br /> 16. GENERATOR'S CERTIFICATION: Iherebydedarethat the contenh of this consig mentaro fully and acc«alely described above by proper ship in nomaandarodas.ihed,pocked, <br /> marked,and labeled,and are in all respects in proper condition for transport ay highway according m applicable international and notionargovernment regulations. <br /> If I am a large .anti <br /> 8 9 generator,1 certify that 1 have a prssgram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economic. <br /> { N <br /> practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human hea <br /> and the environment,OR,if I am a smaquantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that <br /> O available to me and that I can afford. <br /> y Pdnted/T Name Shggamre ' <br /> U .. S Month Day 1 <br /> W 7 17. Trans r cIm led ement of R«ei t of Materials <br /> R <br /> W Prinled/Ty „fn Sig amre Month . Day/ !1 <br /> a 1 R. Tr s rmr 2 knowled menti of R«ei t of Mamriall <br /> O <br /> R Printed/Typed Name <br /> W E Signature Month Day 1 <br /> Q R <br /> j Z F 19. Discrepancy Indication Space <br /> A <br /> C <br /> I <br /> b <br /> i• <br /> 120. F.,MN Owner or Onsenntor Certification of r«e'h f of hazardom materiels covered by this manifest exca t as noted in Item 19. <br /> t T <br /> Y Primed/Typed Name Signature Month Day T <br /> i <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) <br /> EPA 8700-22 -;Ekr nIN <br />