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S4 to Of Galitorni Ith and Welfare Agency -1 ' J u bee rnSaruc.vorw u -j <br />F�� OM® No. 2060-0039 (Expires 9.30.91> and Front of Page 7 <br />Ppq print or type. Form designed for use on (12 -pitch 12itch typewriter). <br />-T UNIFORM HAZARDOUS enerator's US EPA ID No. <br />WASTE MANIFEST L I. . <br />3. Generator'spName and Mailing Address pg <br />V,azz)nd and Eas r-.rth <br />4. Generator's Phone ( ) <br />Manifest M2. Page 1 <br />Document No. of <br />1 i t 1 s <br />W 16. Transporter 1 Company Name 8. US EPA ID Number <br />7. Transporter 2 Company Name S. US EPA ID Number <br />J <br />U <br />e <br />i") Z <br />1 0 <br />Q <br />m <br />v <br />a <br />Y <br />W <br />Z <br />W <br />U. <br />W' <br />09 <br />Z <br />n <br />V) <br />W <br />Q <br />a <br />Z <br />0 <br />a <br />Z <br />J <br />J <br />Q <br />U <br />J <br />J <br />0 <br />U <br />Z <br />CW9 <br />fZ <br />W <br />LU <br />W <br />Q <br />Q <br />W <br />crL <br />G <br />E <br />N <br />E <br />R <br />A <br />T <br />O <br />R <br />T <br />R <br />A <br />N <br />S <br />P <br />O <br />R <br />T <br />E <br />F <br />A <br />C <br />I <br />L <br />T <br />Y <br />Toxic Substances Control Division <br />Sacramento, California <br />Information in the shaded areas <br />is not required by Federal law. <br />Document Number <br />0 11 07 's <br />tats T er's to,.. <br />Transportar's I"" ( 1 rag Z35-1322 <br />State Tmasportees to <br />Traftsp~s Phone <br />9. Designated Facility Name andSite Address 10. US EPA ID Number G. Stats FaoHlty's ID <br />T. fin fid. 5 . men'4 i. Fat..7° iii, arsir',,t, <br />PvCarnegie f,'a p t° r, <br />K Fa s Friona ° Ela° ST. cl <br />12. Containers 13. Total 14. L <br />11. US DOT Description (Including Proper Shipping Name, Hazard Class, and ID Number) Quantity Unit Waste No. <br />No. Type ±2201 <br />a. o <br />Rr-R": Hazatf"d?" s wasTe Solids EPA/ <br />QfiW <br />C. <br />J.I Descriptions for Materials Listed Above <br />P 86r:ra g7A�� <br />State <br />EPA/Other <br />K Codes ttu Wash Listed Above <br />a. b. <br />�. d. <br />16. <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 4o applicable international and <br />national government regulations. <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 <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. I have made a good faith effort to minimize my waste <br />generation and select the best waste management method that is available to me and that I can afford. <br />Print)rdYTypad Name = Signature Month Day Year <br />4 <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />Printed /Typed Name Signature Month Day Year <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />Printed /Typed Name Signature Month Day Year <br />19. Discrepancy Indication Space <br />'B. NA MIG36 CC )38 <br />Facility Owner or <br />ted /-Typed Name <br />DHS 8022 A <br />EPA 87OD--22 <br />(Rev. 8.89) Previous editions are obsolete. <br />Certification of receipt of hazardous materials covered by this manifest except as noted in Item <br />Signature <br />I V ):ZILI 1�> I Z�11�a I — <br />Do Not Write Belo4 This line <br />Month <br />Q <br />WHITE: TSDF RETAINS <br />