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Sb1P of Cah n1a—Ergli ProMction Agency <br /> pm AyRr OAFI Ng,�6A�pRj9lEnp rm 930-991 Ia .See Insfructionv o* n hock X099 b. Deparlmenr of Toxic substances Cant- <br /> at <br /> am- <br /> w pant tYP*. lbrm die g, For use oa*lift F 12 pilo-,ewries, S.,mare nb,California <br /> P1 �lNIFORM HAZARDOUS 1. Generators US EPA ID No. Manifest Document No, 2, Page I Information in the shaded areas <br /> J WASTE MANIFEST Is not required by Federal law. <br /> L of <br /> 3. Gemraror's Name and Mailing Addrus fel Tek/A6nifesf D9cdment Number - <br /> L''"t'�R"R't''` 98756135 <br /> 0 *1 E.Charter Way Stockton,CA 95206 B. State Generator's ID <br /> A. G*nerobr's Phone <br /> 209jM882d1 AHrt: t3ary <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID <br /> h <br /> oRannas% Enrifittw ..ental 11,11414 0 Q 3 D. TransportersPh.. 916-371-5747 <br /> 0 <br /> aD 7. Transporter 2 Company Name 8. US EPA 10 Number E. Stare Transporter',1D <br /> QF. Transporhr's Ph" <br /> V erred F�i g Narund Site Address 10. US EPA ID Number G. sto f iy's ID, <br /> Lf)Z arrt 26thkh 91- ` r <br /> M K Los Anneles, CA t r.3 H. Focilitl/s Phone 268-5JO56 <br /> Q 12. Contain... 13. Total led. Unit <br /> A l.J 1 i. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Num6erl No. T Quantity Wt Vol 1. <br /> y� pe ry / '}Vast*Number <br /> 0 _ N(114-RCRKIWARDOU3 WASTE-So L,i D EDA/Other r <br /> 3 Oflft orber>t DM P w� <br /> o N b, stare <br /> m E <br /> R THIS WASTE STREAM HAS BEEN QUALI IE. EPA/O her <br /> T TP RECYCLING/TREATMENT AT THE State <br /> co <br /> R EINVI ;MMENTAL FACIUTY 'N LOS NGELE , EPA/Other <br /> ;,749koi, 418 FAGI6ITY 14A" E <br /> z d. eERMITS TU RECEIVE YOUR WASTE STREAM AS sae <br /> QUALIFIED. OUR EPA NUMBER iS CATO 0 3 6 PA Qlh" <br /> W <br /> Z <br /> Additional Dascripfions for Materials listed Above K. Handling Codes for Wtrsfts L'sted'Above <br /> 0 A >< 5' a. 6'.. <br /> W <br /> Z <br /> I s s *tial Handling Instruction,and Addr ere IIF mane* <br /> O <br /> i.�lVtur-. BE 40 HOUP u`Sr J�iAFA TP;; NEC,! NL) ii t-�c NI EEA N-t--ROVEC) PP2' <br /> Z -MERGENCsi COMA( T: (818)371.5;47 .5 ;o6# Profile# <br /> = 2081 E.Charter Way, Sb lwn, I A, 85205 �8�1�c� N53 Soy <br /> 16. GENERATOR'$ 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 /> marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> J If I am a large quantity s <br /> generator,I certify that I have a program in place to the volume and toxicity of waste generated determined degree I have dermined Io be economical <br /> d practicable and that ova selected the practicable method oI treatment;storage,or disposal currently available to me which minimizes the present and future threat to human heolth <br /> N 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 /> oc <br /> available to me and that I can afford. <br /> O <br /> } Printed/Typure ed Nome _ Signat — Month Day year <br /> U , Cl <br /> Z <br /> W <br /> C0 T 17. Transporter 1 Acknowleclarnment 001so.iPst of Materials <br /> p �p <br /> M Printed/Typed Nam _ ✓/1' L1 t,S Sig ami* �, Month Day Year <br /> w Is 13 11 <br /> W 0 18. Trans rte,2 Acknowled ement of ReceiFit of Materials <br /> 0 R Printed/Typed Name Signatare Month Day Year <br /> 7 <br /> w p <br /> Q R <br /> U 19. Discrepancy Indication Space <br /> Z F <br /> — A <br /> C <br /> 1 20. f cili or or Cleraror Certification of receipt of hazardous materials covered by his man.f ue t as in Item 19. <br /> T Prin Ty d oma - Signature1 qQo D V� <br /> Y c�vd ver. ear e,-Z- 2 106 p <br /> DO NOT WRITE BELOW TffK LINE. <br /> Ye!L, TSDF SENDS THIS Q TO GENERATOR WITHIN 3? DAYS, <br /> DTSC 8022A I4/971 (Generators who submit hazardcas -woste icr maraperr out-oF state. <br /> EPA 8700-22 produce compiered copy of this copy and send to DISC within 30 days. <br />