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State of CaTifornia—Environmental Prqtection Agency <br />form Approved OMB No. 7050-0039 (Expires 9-30-99) <br />Please print or ;coTi designed for use on elite (12 -pi <br />• ' UNI ORM HAZARDOUS <br />,. TE MANIFEST <br />e� <br />3. Genera a ing ress <br />'� 9 "T <br />f T.e f <br />h4. Gene/at 'RPh <br />N 5. Transpo er C p ny <br />LO <br />co <br />0 4rat,..A �N <br />O <br />g/Rey CP 7. Transporter 2 Company Name <br />See Instructions on back c <br />ricer. <br />1. Generator's US EPA ID No. Manifest Document <br />'A IN LR I i I tJl .Tl 11 1 I 1 'ric., 10 1 <br />Y <br />us 0Ax91&0Cr; <br />8. US EPA ID Number <br />s°q <br />wrof Q <br />u 9. Drign�ted Facility Name a d Site Address 10. US EPA ID Number G. St <br />W 37 <br />J <br />Q fU <br />12. Containers <br />.� u <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and Number) <br />r. �= <br />,ID <br />q <br />0. �t$.� fPOr��"'P " Z AIII&O C6^5 <br />E <br />t' / <br />6 J'.r!`�s � �jay,,{j �'� �" oAw°i'w' <br />o <br />E <br />b6 v'%1?.^e91��t7c+✓�.c ' c �� f" <br />04 <br />A <br />C. 11tE <br />- DISp°S EPQV K. <br />ASTE <br />oT <br />as <br />O <br />R <br />peRnllTg 71Zc� WAS <br />0 <br />w <br />d. rhelarvptoN TarE,N. !3y <br />°�¢ coNsr'�1 PRO <br />Ft�tq� <br />w <br />u <br />U1 <br />p � ANgy l3iVgn <br />`""hnS STA7gi °N <br />ACCORDtt�:,-L®TT <br />rn J. Additional Desciiptions far. Mate <br />o , <br />W <br />Z <br />OF <br />ME <br />]e 6• Department of Toxic Substances Control <br />Sacramento, California <br />2. Page 1 Information in the shaded areas <br />is not required by Federal law. <br />of <br />lone <br />41,E . <br />13. Total 14. Unit <br />Quantity Wt/Vol L W <br />Staff <br />EPA1 <br />i Stale <br />State <br />OF yNl 00 ER "R <br />w , <br />N E R .,g <br />U 19. Discrepancy Indication Space <br />Z F <br />A <br />C <br />L <br />f 20. Facili Owner or Operator CertificatiaiLof receipt o <br />j Printed/Typed Name <br />y <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />. t� ,rte, <br />DO NOT WRITE' LOW THI NE. <br />Yellow: TSOF ENDS THIS COPY,/0GENE`fZATOR WITHIN 30 DAYS. <br />(Ge rotors who submit hazardous waste for transport out-of-state, <br />py duce completed copy of this copy and send to DTSC within 30 days.) <br />V <br />15. Special Handling Instructions and Additional Inform tion / <br />w <br />,. �,, +t`fC�F "isib'/�c�i DC7P n'� fir" f 1 <br />�✓ f P } <br />t' / <br />6 J'.r!`�s � �jay,,{j �'� �" oAw°i'w' <br />Umarked, <br />16. 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 />and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br />—J+ <br />N <br />If I am a large quantity generator, I certify that I have a program in, place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <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 health <br />and the environment; OR, if 1 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 />� <br />available to me and that I can afford. <br />4 <br />Printed/Typed Name <br />Signature s ' A'Ar'" - ° <br />Month Day Year <br />Z3T <br />C7 <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />Wp <br />R <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />uL <br />0 <br />18. Transporter 2 Ackno4viedgement of Receipt of Materials <br />R <br />Name <br />T <br />Frinted/Typed <br />Signature <br />Month Day Year <br />w , <br />N E R .,g <br />U 19. Discrepancy Indication Space <br />Z F <br />A <br />C <br />L <br />f 20. Facili Owner or Operator CertificatiaiLof receipt o <br />j Printed/Typed Name <br />y <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />. t� ,rte, <br />DO NOT WRITE' LOW THI NE. <br />Yellow: TSOF ENDS THIS COPY,/0GENE`fZATOR WITHIN 30 DAYS. <br />(Ge rotors who submit hazardous waste for transport out-of-state, <br />py duce completed copy of this copy and send to DTSC within 30 days.) <br />V <br />