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State of California—Environmentol Protection Agency <br /> See Instructions on baCl, c page 6. Departmental`To.;,Substances <br /> Form Approved OMB No.2050-0039 IExpirss 9.30.991 te <br /> e r r. Sacramento,California <br /> Please print or type. Fenn designed{or uw on elite(12- p w i <br /> 1. Generator's US EPA ID No. Manikst Document No. 2. Pogo 1 rmation in ts <br /> Infohe haded areas <br /> UNIFORM HAZARDOUS I no rpuired by Federal law. <br /> WASTE MANIFEST ALC1201s °f 1 <br /> 3. Generator's Name and Mailing Addmss Liy�r�.,s n/'� y,�M 1^` A. State Manifest DoEumeN Number <br /> 229063:2 9 0 A 3 <br /> lk 0 kIa L7+-t,&L <br /> v�vl�T B, Slate Generally s ID47) <br /> YV;J1 <br /> - -�� ` <br /> d. Gene s Fane <br /> N 3. Transporter 1 Company Noma 6. US EPA IDN. bet C. Scot.iransporteds ID lRese_rved.j 3544 <br /> mD. Transported,Phone <br /> FREMOUW ENVIRONMENTAL INC CAL 0 0 0 2 1 8 5 8 7 (707) 448-3700 <br /> mE. $tate Tram orter's ID Re <br /> _ 7. Transporter 2 Company Name 8. US'EPA ID Number P f <br /> kpO 770 -F. Transporter',Photo <br /> M`v 9 of F�Ii•��me le�JJ/dd/er(as/> 10. US EPA ID Number G. State Facility,ID <br /> CD a B7TC VIW1I NWAte'4� D <br /> Oz 3650 EAST 26TH STREET, LOS ANGELES, CA 90023 H. Faailiyr,Phone <br /> gyp CAT080033681 (888) 871-7222 <br /> U - H and ID Number No Cantamers 13. Tocol 1 d. Unit <br /> I1. US OOT Description(including Proper Shipping Name,Hazard Class, I No. T Quantity Wt/Vul 1. Wash Number <br /> Z ° • lta 1 <br /> ( rR E <br /> 3 G <br /> State <br /> 60 <br /> o N b. <br /> so E EPA/Other <br /> a R <br /> YA- C. .• Sate <br /> 8 T <br /> O '.EPA/Other <br /> R <br /> d. State <br /> r <br /> Z EPA/Other <br /> W <br /> V <br /> W <br /> ,'s J. Add"anal Dascrsptions fo esiali Listed K. Handling Codes for Wastes Listed Above <br /> g tloL� O�lade l lin kg 33022y-1 S' a3 b. <br /> W <br /> as - c. d. <br /> J <br /> Q <br /> O13. Special Handling Instructions and Additional Information <br /> _ HANDLERS TO BE TRAINED AND WEAR PPE. <br /> EMERGENCY PHONE# 916-371-5747 <br /> x <br /> 16. GENERATOR'S CERTIFICATION: I ha..bydeclaret at th.ocetenbof this consignment are fully,and accurately described above by proper shipping name and an classified,packed, <br /> Umarked,and labeled,and are m all respects in proper condition for transport Dy highway according to applicable international and national gowrnmen,regulations. <br /> =+ <br /> IF I oro a large quantity genoraror,1 uM(y that I have a pr ram in place ro reduce the volume and fazi<iy,of wrote generated to the degree have determined to be economical))) <br /> i Practicable and that I hove selected the procticable method of treatment,storage,or di,p I currently available to me which minimizes the present and Futore threat to human health <br /> and the environment,OR,if I a a small quantiy generator,I have mode a good faah eIT to minim...my wast.gen otsti select the bot waste management method that it <br /> available to me and that I c afford. <br /> O <br /> Ni. Signa r Mon �:11 Ye <br /> Z / <br /> W T I Acknowled a Recei t of Materials <br /> oc A ome SignaturEdonOaW 0 2 Acknowled ement of Reci t of Materials <br /> 0 R ome Sig f Month Day Ye <br /> t,t t z z z a <br /> U19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> L <br /> 1 20. Facility Owner or OperatorCedification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Primed/Typed Name signature Menth Day Y. <br /> r /QGlt <br /> t 2 O <br /> DO NOT WRITE BELOW THIS LINE. <br /> White TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DTSC 8022A.(1/991 To: P.O. Box 3000, Sacramento, CA 95812 <br /> EPA 8700-22 <br />