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Slab oF'CaliFornia- Environmental Protection Agency <br /> Form Approved OI B No.2050-0039(Expires 9-30-991 See Instru CLIOns oft back r - sO9E b. Depanmenl of Toaic Subsbn.Com, <br /> itlei print or yp . For'designed far use on elite(12-pilc. pwriler. J <br /> Sacramento,California <br /> NIF RM HAZARDOUS Generaror's US EPA ID No Manifest Document No 2 Page n ormation in the shaded areas <br /> 'A STE MANIFEST of required by Federal law. <br /> I& Is In jj lit 14 <br /> OF <br /> 3. Ge tart s Name and Mailing Address A. to Manifest Docs enc Number g _+ <br /> 9 <br /> h 2"1 E. Chari'e4ay $T66Ckl041 ,0A8326 B. State Generomr's ID <br /> h d. Generator's Phone 1 <br /> n 4 i =, <br /> C4 <br /> 5, Transporter 1 Company Name 6 US EPA ID Number I C. State TmnspcersiI ID gse insi <br /> m <br /> p D. Transporter's Phone <br /> CP Rams Envirmr <br /> eevmei 3 .ir:�s 1 <br /> 7. Transporter 2 Compaq Name 8. US EPA 10 Number E. Slate TransporRese ter's ID I .I er <br /> C.O Q <br /> I F. Trarmporter'e Phone <br /> V 9. Designated Fac liy Name and Site Address 10, US EPA ID Number G. State Facility',ID <br /> Q <br /> . J. ,}150 EFist Mich Vital H. Facility's Phone <br /> Q 1 I. US DOT Description 'ndudio Pro Skipping Name.Hazard C ass.and 10 Number 12. tamers 13. Total 14 Unit <br /> U9 Per PPS^9 N TYae Oucnfiy Wt/Vol I. Was.N -h aw <br /> State <br /> 3 c 'V;I ciCk�r1 r+azo: °e.+i;5 v':+esr,F; Soiid EPA/Otter <br /> ry Np state WA <br /> ETHIS WASTE STREAM HAS BEEN QUALIFIED °1 <br /> y EPA/011ier g <br /> V At <br /> TD/K ENVIRONMENTAL FACILITY IN LOS ANGELES, stele ' <br /> 0 <br /> Iri <br /> RCALIFORNIA.THIS FACILITY HAS THE NECESSARY EPA/Other <br /> z PM AS <br /> ERM s.k <br /> QUALIFIED. OUR EPA NUMBER IS CAT080033681 EPA/Other <br /> w <br /> J. Additional Descriptions kr Materials listed Above - K. Handling Code,For Wastes Listed Above <br /> ZZ <br /> _ <br /> 0 1a)PMW 29Wi 1439 V �j d�A 6. <br /> w <br /> _- c. d. - <br /> Z <br /> O15. Special Handling Instructions and Additional Information <br /> z �A;J,7i ERG BE 47 H 0 U 06tIIIIA RA IRAINE0 A 101,AE isJ10 4.1 n.is,rr,: <br /> w h1ERINCY CONTACT: (916)3713747. s t 9 Cut" <br /> r;;s1 E'I_rar(�t krtsv. 290311-09 <br /> Q 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this con;rmem°re fully and accurately described above by proper ship" <br /> Ing name and are classified,pocked, <br /> V marked.and labeled,and are in all respects in proper condition for transport y highway according to applicable omernational and notiono government regulations. <br /> J If I am large quantity geriiii edify that I have a p.ggram m place to reduce the volume and toxicity of-asm generated to the degree I have determined to be coarr icollY <br /> Npr.ob.ble and that have selected the practicable method of treatment storage,or dieposa'c entry u aJci ro mew ick minimizes the present and future threat to human health <br /> and the environment,OR, if I° mall quantity generator I have mode a good faith effo,•a minimize my we,a generation and select the best waste management method that is <br /> O v <br /> 1°61.to me and that mn afford. <br /> UPrinted,Typed Name Signature Month, Day ld ZYear <br /> z71 <br /> N17. Transporter 1 Acknowled a em of Recei t of Mvterims <br /> w X P iniad/Typed Name - - - Signo't - Month Day Year <br /> w ; y <br /> _ r <br /> uL 0 18. _ orter 2 Acknowledgement of Receipt of Materials <br /> O 1 Prin.d'Typed Name Signature Month Day Year <br /> I E <br /> Q R IF <br /> V <br /> F 19 Clsc:eponcy Indication 5race - <br /> Z= A <br /> C <br /> I <br /> L <br /> 20. Fazilitis Owner or Operator Certification of receipt of hazardous materials covered c e t as noted m 19. <br /> Y P inted: YP�dcN i ( / - Sig.at .e <br /> i s c ., r Dar"'. Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DISC 8022A 11 991 _- <br /> EPA 8700-22 - " d°ys'1 <br />