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Ith and Welfare Agency See Instructions On bacK Ot rage o--v.-"Z... v' "`~"" "-"""'- <br />o. 2050-0039 (Expires 9-30.91 and Front of Pa 7 Toxic Substances Control Division <br />Form desianild for use on elite cit typewriter). Sacramento, California <br />ORM HAZARDOUS toes US EPA ID No. Manifest Paget Information in the shaded areas <br />AST <br />E MANIFEST Document No. <br />of is not required by Federal law. <br />•erstoes Name and Mailing Address R State Manifest Document Number <br />anta Fe Railway b rad LincolnAve. mate ors ID <br />ein re ora ho"�ne C SIS b rJl" ��1 413 I',le <br />i� <br />S. Transporter t Company Name e. US EPA ID Number <br />Ince le 1A Q U) in 12 14 16 If <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />Fort I in d. Treatment Facility, Barstow, G <br />v / ? Q t Carnegier., San , CA 24 <br />Q se .•ia�:.�^ra. � <br />cc <br />; j LL 11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />K <br />a on RCRA HazardousWaste Solids <br />ft G <br />E <br />'S N <br />E b. <br />N R <br />A <br />Y <br />a O <br />N R c. <br />'a <br />go <br />8 <br />w <br />d. <br />Z <br />w <br />U <br />n <br />ETM - <br />0 <br />West) CS c (L _W <br />J <br />Z <br />U 15. Special Handling Instructions and Additional Information <br />H <br />4 <br />Z 24 Hour Contact: Mick Hardin <br />24 Hour Phone: ( 72 ) 386-4081 <br />J <br />J <br />U 18. <br />GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping nems <br />and are classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and <br />a national government regulations. <br />o) <br />if am a large quantity generator, 1 certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined <br />t2 <br />Mto be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the <br />present and future threat to human health and dee e • OR, if I am a small qu ity generator, 1 have made a good faith effort to minimize my waste <br />Ugeneration and select the best waste management method that is available to e a th I can afford. <br />Z Printed/ pe Name Y,, Month Day ,Year <br />Sipnatu <br />cc <br />w � <br />2W T 17. Tre porter Ac nowlsdg ent of Receipt of Materials <br />w R <br />ZJ.- <br />I signature Month Day Year <br />A Printed/Typed Name <br />N <br />O <br />S s <br />P 18. Transporter 2 Ackno% <br />to O <br />q R Printed/ Typed Name <br />U T <br />E <br />Z <br />0 <br />Day Year <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />i 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in hem 19. <br />T Printed /Typed Name Signature Month Day Year <br />Y <br />DHS 8022 A Do Not Write Below This Line <br />EPA 8700-22 <br />(Rev. 8-89) Previous editions are obsolete. <br />YELLOW: GENERATOR RETAINS <br />