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State of Calibrnia—Environmental Protection Agenry, <br /> Form Approved OMB No.2050-0039(Expires 930-99) See Instructions on back Of nage 6. Department of Toxic Substances Can. <br /> Vequ}rlWIPetype. Form designed for use on elite(12-pitc ,writer -Sacramento,California <br /> UNIFORM HAZARDOUS Generatoi s US EPA ID No. Manifest Documt .en2. Page 1 Infomwtion in the shaded areas <br /> WASTE MANIFEST I. wtregairedbyFederal law <br /> . <br /> of <br /> 3. Generator's Name and Mailing Address <br /> 95205 Genemtor'iID <br /> n4 Generators Phoned I _ I { I I t <br /> N S. Transporter I Company Name b. US EPA ID Number , -tato Transponer's ID jP.eserond I <br /> N <br /> p <br /> D. ironsporter's Phan <br /> CP 7. Transporter 2 Company Name 8. US EPA I Number Transporter',ID IRe e v .I <br /> Qrdnsponer's Phone <br /> U 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State fadllty's ID <br /> s t r•-t rJ CA 94023 H. Fac tyPhone <br /> ,y�.0 11- US DOT Description(Including Proper Shipping Nome,Hazard Class,and ID Number) 12. Containers 13. Tota led. Unit <br /> No. T Quantity WI/Vol 1aete Number <br /> State <br /> 3 G . .._ _ l EPA/Other <br /> E .:.G2 i 1 <br /> o N b_ State <br /> co E <br /> R EPR/Other <br /> v A <br /> o T state <br /> 0 O <br /> R other <br /> � d <br /> z <br /> W <br /> U Other <br /> W <br /> Z <br /> J. Additional Descriptions for Materials Listed Above "re <br /> O 7 Q T-.'r r Ji <br /> 11A) .r3_ilcf 931. �f <br /> W <br /> a —ni <br /> Z <br /> O 15. special Ha of ,1,,t...tons d Addri.. I nfron ' <br /> 5 �� / � Y,i <br /> z '-7 TRA 3D <br /> -s I& GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are 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 government regulations. <br /> If oat a large quontiq generator, I certify that I have a progra in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be economically <br /> N practicable end that I have selected rhe procticable method of treatment,storage,or disposal currently available to me which minimizes the present and futvra threat to human health <br /> and the environment;OR, If I am a small gvamiry generator,I have made a good Faith ezrt ta minimize my waste generation and select the best waste management method that is <br /> O <br /> available to <br /> and that I can afford. <br /> } Printed/Typed Nome Signature Month Day Year <br /> Z 1 s•..it i <br /> W T 17. Transporter I Acknowled a ent of Receipt of Materials <br /> w R Printed/Typed Name Signalbia /r1 ( s Month Day Year <br /> 0 'I8. Transport 2 Acknowled .teem of Recei t of Materials - <br /> O I Printed/Typed Name Signature Month Day Year <br /> W E <br /> Q R <br /> U 19- Discrepancy Indimti on Space <br /> Z F <br /> A <br /> C <br /> 20. Facie Owner or O rotor Cern Rcotion of receipt of hazardous materials covered6 this monifest exce t os is din Item 19. <br /> T Printed/Typed Name Signatum Moods Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A 11/991 <br /> EPA 8700-22 Yellow: GENERATOR RETAINS <br />