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Stale of California—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 fExpires 9.30-99) See Instructions on back of <br />Please print or type. Form designed for use on elite 112 -pitch) r b• <br />UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document Na. <br />WASTE MANIFEST A L D 0 0 01 1 8 1 8 1 7 7 6 D <br />Trar'splome and Mailia�dAdress <br />GU LLC7r llYt.` A. Slab Mani <br />13282 ESCALON—BELLO'PA RD. <br />o ESCALON, CA 95320 e. smtecene� <br />4. Genamror's Phone 1209 ) 838-3731 <br />(`! <br />S. Transporter 1 Company Nama 6. US EPA ID Number <br />C. stole Trans( <br />h <br />SHOPHAZAR <br />o DS SOLUTIONS C A D D 0 0 6 4 6 4 9 7 D. Transporter <br />7. Transporter 2 Company Name <br />B. US EPA ID Number E. stale TransF <br />QI I I I F. Tronsoorter' <br />1630 W 17TH ST <br />LONG BEACH, CA 90813 <br />EPA ID Number <br />8 19 10 I1 19 <br />Department of Toxic Substances Control <br />Sacramento, California <br />Page 7 Information in the shaded areas <br />is not required '_c. low. <br />of 1 <br />Document Number 22091505 <br />(500)748-7449 <br />(562)432-5445 <br />V I. uJ UOI Description (including Proper Shipping Name, Hazard Class, and ID Number) 12. Containers <br />13. Total <br />14. Unit <br />T e <br />Z a c No. <br />Quantity <br />WI/Vol <br />I. Waste Number <br />= NON—RCRA HAZARDOUS WASTE SOLID <br />Stale 223 <br />3 G 0 0 <br />E <br />D wi <br />7 0 <br />P <br />EPNAJ4Pr-Lec3 <br />N b. <br />E <br />state <br />AEPA/Other <br />m 0 <br />Slate <br />R <br />a, <br />EPA/Other <br />d. <br />Z <br />Stale <br />W <br />U <br />w <br />EPA/Other <br />n <br />Z <br />t nab listed Abovs <br />K. Handling Codes for Wastes <br />Listed Above <br />so <br />B. <br />Y <br />Y <br />C. <br />d. <br />hf p*6p*jXlrE'^pq&p&4?S�i ^ 'L2SR Nc <br />"DIERGENCY CONTACT:(800) 746-7449" <br />SEE E_R.G. PAGE 4 171 <br />u <br />16. GENERATOR'S CERTIFICATION: 16 ... by declare that the contents of this consignmenl ore fully and accurately described above by proper ship ing name and are classified, packed, <br />marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international <br />and notionaPgovernment regulations. <br />j <br />If I am a large quontiryry generator, I certify that I have a proggram in Place to reduce the volume and baiciy of waste generated to the degree I have determined to be economically <br />practicable and theft have seeded the <br />ronicable method of treatment, storage, or disposal currently avoilable to me which minimizes the present and future threat to humors health <br />and the environment; OR, if I am a small quantity generator, I have made a good faith effort to <br />�irlimiza my waste generation and select the best waste management method That is <br />available to me and that I can afford. <br />Prinled/Typed Name <br />__E' Stgn ur /j Month Day Year <br />c/ l�iv.�Ee /' Eti�/Y � � { <br />.!G _ y 3 v <br />N17. <br />Trans oder 1 A knowlid t of Receipt of Materials <br />A <br />Printed/Typed N t Signa <br />5 <br />P <br />Month Day Year <br />��` 0 930 <br />R <br />03 <br />18. Trans attar 2 A<knowled amens of Re<ei t of Materials <br />T <br />Printed/Typed Name Signature <br />E <br />R <br />Month Day Year <br />79. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />20. rOctity Owner or Operator Certification of receipt of hazardous materials covered by this manifest exce t as noted in Item 19. <br />T <br />Printed/Typed Name Signature <br />Y <br />Month Day Year <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />WU NUI WKIIE BELOW THIS LINE. <br />Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />To, P.O. Box 400, 5acromento, CA 95812-0400 <br />nkP,v <br />