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W) <br />u5 <br />n <br />Cv <br />OP <br />J <br />J <br />U <br />Z <br />Z <br />(� Np <br />W <br />CD <br />a <br />N <br />QQQ <br />W <br />W <br />t - <br />Z <br />W <br />Q <br />�z <br />C <br />u <br />ea <br />4 <br />C <br />State of r nia--Health and Welfare Agency See instructions on Beck of -Page 6 Department of Health servecee <br />J No. 9 (Expires 9-30-91) S" (Q —q)p and F'rnnt Of Pace 7 Toxic Substances Control Division <br />e ; r type. Form desi ..bd far use on elks pitch typewriter). <br />F®RM HAZARDOUS aerator's US EPA to No. Manifest <br />WASTE MANIFEST Document No. <br />Generator's Name and Mailing Address * r. <br />6. Transporter 1 Company Name 6. US EPA to Number <br />7. Ttansobtfe7 2 <br />9. Designated Facility Name and Site Address 10. US EPA ID Numbs <br />F; d 'ArwI^ Rd. Troatmen. Fa!^.( h'i's Bars -,-Vi, C! <br />C 'C 3 L Cay° Cprnegic, Dr.. Sip: d r-* CA, 924C. <br />11. US DOT Description (Including Proper Shipping Name, Hazard Class, and ID Number) <br />a. <br />G nrt at m-Pdt" ^t# jaSt a 'r n1 i # <br />E <br />N <br />E b. <br />R <br />T <br />O <br />R c. <br />2. Page 1 Information in the shaded areas <br />04 is not required by Federal law. <br />A. State Meaffea4 Document Wilber <br />S. State Generator's ID <br />C. State Transooner's ID <br />F. Transp~s Phone <br />G. State Faoflity's ID <br />K Fa~6 Phone <br />2.Containers 13. Total 14. <br />Quantity UnR <br />No. ( Type Wt/Vol <br />-- EPA)OUW <br />d. State <br />EPAIOttrer <br />J. Additional Doeoriptione for Materials Listed Above K Handling Codes for Waatas Listed Above <br />a. b. <br />Diesel 01 - lr*, t, � d. <br />FI �q i r if : S ek- p -: ? 411 1 C' <br />18. <br />GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <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 />national government regulations. <br />If I am a large quantity generator, 1 certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined <br />to 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 the environment; OR, if I am a small quantity generator, 1 have made a good faith effort to minimize my waste <br />generation and select the best waste management method that is available to me andthat I can afford. <br />Printed/Typed Name Signature Month Day ,Year <br />T 17. Transporter t Acknowledgement of Receipt of Materials <br />R <br />Printed/Tvoed Name Signature Month Day Year <br />- P <br />s O 18.'Tranipofter 2 Acknowledgemeai'of Receipt of Materiels <br />R Printed/Typed Name <br />i T <br />E <br />19. Discrepancy Indication Space <br />F $. WANK 3`- oD-r38 I <br />A <br />C <br />I <br />L <br />1 20. Facility Owner or Operator Certification of receipt of ha. <br />T <br />y PrinRd/Typed Name <br />DHS 8022 A / <br />EPA 8700-22 <br />(Rev. 6.89) Previous editions are obsolete. <br />materials covered by this manifest except as <br />Signpture <br />ft77►� . f� <br />Month Day <br />Month <br />WHITE: TSDF RETAINS <br />