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_ State of Califq-nia-Environmental Protection Agency <br /> Form Appro OMB No.2050-0039(Expires 9-30-991 See Instructions on back of ]a 6. Depart of Toxic Substances Cont, <br /> Plea».print or type. Form deigned for use on slim 112-pitch)Opero rimy. mss/ Department <br /> Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 nFormation in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST Q 151611 2of 7 <br /> 3. Generator'sNameandMoiling Address A.-ShW)tIasti(titD6ctisiientNumber 56135 <br /> OF#tad Rorskal% <br /> e 2DB7 E.Ckaster MFey Stockton,(:A 9152W g. State Germrowes 1D <br /> h4. Generator', Phone( 1- aeul is oV <br /> n <br /> N 5. Tronspornr 1 Company Name 6. US EPA ID Number C. SroN Transpornr's ID <br /> h g 5R-/ <br /> m {Zanwa Efsvlf'csnrntntal tft.'fYiCtC9 {,; �9 400 � I� TJ D. Trans nee,Phone <br /> 8 <br /> to 7. Transporter 2 Company Nama 8, U8 EPA ID Number E. Slam Transpornr's SID <br /> f. Transporter',Phone <br /> �p.d Sim Address 10. US EPA ID Number G. Stam Facility's b <br /> H. Faclirys Ph . <br /> O Lor As1!ples , CA !KAYYJ eC8 0 y 3 J 213-768-5056 <br /> zi <br /> Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Num6er) 12. Containers 73. Taal 14. Unit <br /> Ln V No. Type Quantity Wt/Vol 1. Waste Number <br /> 0000 1 6(4-R(;RA FLAZARDOUS WASTE �01.�0 ,am <br /> t - E) P EPA/Other <br /> GA3 G (O�JAklsofn t) NACQ afa1-I1 o G <br /> o N b. ,tam <br /> m E <br /> V R EPA/Outer <br /> NV A c <br /> o T State <br /> W G EPA/Other <br /> R <br /> W d. Sem <br /> 1- <br /> Z <br /> U EPA/Other <br /> w <br /> A Addi6onol Descriptions for Materials Listed Above K. Handling Godes for Wastes Listed Above <br /> ZO A} .Tr $ J b. <br /> H <br /> W <br /> z d. <br /> eE <br /> I of o ipg l tru Y n d f talo <br /> O i:�t^J�°I`_tl��c 1� t�,�t�f°ni����ri'S.�,���+,'�li•icli 43fJt Lt:�F_hUL`l-�ri 1=N'?F:'pVEC� 'r-F"C. <br /> Z MERGEhK;Y CCfJTACT: (M)3711-5747 �}� tt, r nn i•# <br /> = 2081 E.Charter Way, Sex l hin, CA, 95205 <br /> 16. GENERATOR'S CERTIFICATION: Ihereby declare that the contents of this consignment are fully and accurate)YY described above by proper shipping name and are classified,packed, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to app lica6le international and national government regulations. <br /> J IF 1 am a large quaaiq generator,I certify that I havoc pro <br /> �ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economicallyy <br /> 0- practicoble and that I have selected the practicable method aF treatment,storage,or disposal currently available some which minimizes the present and future threat to human heahh <br /> h 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 /> available to me and that I can afford. <br /> O} Printed/Typed Noma Signature Month Day Year <br /> it <br /> W 1 17. Transporter 1 Acknowledgement of Receipt of Material c ` <br /> W j Printed/Typed Name? Sigl(cture Month Day Year <br /> W 5 \ �� 1t�F\AL-rcl2 - _ t �.._ 0 3 5 <br /> W <br /> al 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> 0 i Printed/Typed Name Signature Month Day Year <br /> h E <br /> Q R <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> — p <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Conification of wei t of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> I <br /> DTSC 8022A(4/97) `ally GENERATOR RETAINS <br /> EPA 8700-22 <br />