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19 t 35tate Pf CalifbmiAgency i fc?Mt+*ved OMB No. 2050-W!19 (Expires 9-30.%) 1 ns on back ofa 6. ret or ". Form desirW for use an site (12pefde) wiser.My- Z971 r Pia UNIFORM H ZAR US 1. Generator's US EPA ID No. Manifest Document No. WASTE MANIFEST 0 A i "3 8 i 4 5 3 Q 4 ,4 0 0 O 2 Nam 3. Generator's Naand Moiling Address ® �T �F Y IRO A. D y SAO 20 X r I BMIMP40, CA 92408-3571 C4 4. Generator's Phone 00`x) 386-4083 5. Transporter 1 Company Name 6. US EPA ID Number -, 7. Transporter 2 Company Name 8. US EPA ID Number Q U C4 E 00 N b..� V R' MIMIJ of roxk Control California. 2. Page 1 Information in the shaded are is na4 requirod Fedawl law. of - 13. Total 1 14. Unit C<+ LAI11r, _ �010 1� I 0101 X12.15 15. al Handling Instructions and Ad!"l Information Al *,O. 1 Ila, -r 16. GENERATOR'S CERTIFWATION: 1 hereby declare that the contents of this consignment aro fullyamJ accurately described above by proper shipping name and bre.ciaaified, QU packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national govemmet regulations. JIf I am a large quantity generator, I certify that I have a program in place to reduce dw volume and toxicity of waste generated to the degree 1 have-dstenni edto' be a economically practicable and that 1 have selected the practicable method of treatment, skwage, or disposal currently available to me whidr minimizes the present and future - t/9 throat to human health and the environments OR, 9 1 am a small quantity generator, I have made a good effort to minimize my waste generation and select the best IY waste management method that is available to me and that I can afford- 0 fford ® /Typed Name r g• ! / _mon !! f� r #-''' 5 Z T 17. Tr r 1 Acknowled of Receipt of Materials (� A Printed/Typed Name Sigfnaturo Day Year PLLJ _ - _.- LU 0 18. Transporter 2 Ackrawled of Receipt of MateriaeIt r U. T Printed/Typed Name Signature Moth Day Year R (n 19. Discrepancy Indication Space Q U e A Z C I L 20. Facility Owner or Operator Certification of receipt of 1 /Trr ► 4 r MIMIJ of roxk Control California. 2. Page 1 Information in the shaded are is na4 requirod Fedawl law. of - 13. Total 1 14. Unit C<+ LAI11r, _ �010 1� I 0101 X12.15 15. al Handling Instructions and Ad!"l Information Al *,O. 1 Ila, -r 16. GENERATOR'S CERTIFWATION: 1 hereby declare that the contents of this consignment aro fullyamJ accurately described above by proper shipping name and bre.ciaaified, QU packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national govemmet regulations. JIf I am a large quantity generator, I certify that I have a program in place to reduce dw volume and toxicity of waste generated to the degree 1 have-dstenni edto' be a economically practicable and that 1 have selected the practicable method of treatment, skwage, or disposal currently available to me whidr minimizes the present and future - t/9 throat to human health and the environments OR, 9 1 am a small quantity generator, I have made a good effort to minimize my waste generation and select the best IY waste management method that is available to me and that I can afford- 0 fford ® /Typed Name r g• ! / _mon !! f� r #-''' 5 Z T 17. Tr r 1 Acknowled of Receipt of Materials (� A Printed/Typed Name Sigfnaturo Day Year PLLJ _ - _.- LU 0 18. Transporter 2 Ackrawled of Receipt of MateriaeIt r U. T Printed/Typed Name Signature Moth Day Year DTSC 8022A (1/95) EPA 8700-22 re Math Day Year DO NOT WRITE *OW THIS LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS._„ (Generators who submit hazardous waste for transport out of stcte, produce completed copy of thi; copy and send to DTSC within 30 days.) R (n 19. Discrepancy Indication Space Q U F A Z C I L 20. Facility Owner or Operator Certification of receipt of 1 /Trr ► 4 r DTSC 8022A (1/95) EPA 8700-22 re Math Day Year DO NOT WRITE *OW THIS LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS._„ (Generators who submit hazardous waste for transport out of stcte, produce completed copy of thi; copy and send to DTSC within 30 days.)