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Stale of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-99) See Instructions On bOCI( 0 e 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12-pik rites Sacramento,California <br /> enararor',US EPA ID No. Manifest Document o. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal law. <br /> WASTE MANIFEST t' A 'R 0 () 0 i ,t '`i '1 ). 4 5 3 of <br /> 3 G nest, t, n and Moiling Address A. State Manifest Document Number O <br /> I.T <br /> 7464 <br /> F' - B. State Generator's ID <br /> O ry1;. �. tK ;I)ij <br /> 4 Generator's Ph°oe l 1 467 -` 5Fa <br /> N <br /> N 5. Transporter 1 Company Name 6, US EPA ID Number C. State Tramporter's ID IReserved.l <br /> h <br /> :,HM1!);` E)ItLAT'Ii:) :,s,tL'r(i'T'1(?NS C' A 0 0 0 0 6 4 15 9 '7 D. Transporler'e Phone <br /> w 19001746-740 <br /> O <br /> � 8. US EPA ID Number E. State Transporler's ID[Reserved.] <br /> 7. Transporter 2 Company Nome <br /> rr -u F. Transporter's Phone <br /> C*} Q <br /> �'U 9. Designated Facility Name and Site Address 10. US EPA ID Number G, State Facility's ID <br /> r _ f (TB:M-RAN010 CCRDOVA, l,t,c, <br /> CD Z 1 1405 WK1,11r, R(X K P0. tN.. Typ. <br /> e <br /> ,F—I2 RAN(J30 (X)RDOVA, CA 9.r>Y42 C A 4) it 0 [) 0 9 4 97:6 $b7.-0988 <br /> 1 Q . Total 14. Unit <br /> U 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number)) aantity Wt/Vol I. Waste Number <br /> StateNON-T+c11n [iA1ARDGu9 i1A3Tla :tarttaa z23,35;LSANDIKIT R q1 L EPA/Other <br /> G 1 (} 0 A I7pT3--rrara <br /> N E b. State <br /> o N <br /> W E EPA/Other <br /> v R <br /> Ac. Stotts <br /> o T <br /> O EPA/Other <br /> — R <br /> w d. State <br /> H <br /> sZss EPA/Other <br /> U <br /> w <br /> J. Additional Descriptions for Materials Listed Above K. Handling Codas for Wastes Listed Above <br /> OZ g) TtkCU1(S 1;1 <br /> a, b. <br /> N <br /> w <br /> d. <br /> Q <br /> Z 15. Special Handling Instructions and Additional Information <br /> AiF"TrFtC?T't1T A"(Ti T'.'irC-1111("I LVVI Cl frf1I N61 /1i +TCCA 1`17— A41 S HATM1501; ST., riITCKTON, CA 9.SMU <br /> Z "47fA;i r61rN r CONTACT; (200) '146 7,149`• <br /> w 4789; N'.R.0?- F'Atfi: lt^! i'l <br /> x <br /> h <br /> —' I& GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> Umarked,and lobated,and era in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> If I am a large count;ty 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 to be economically <br /> a praclicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method shot is <br /> w' available to me and that I can afford. <br /> OPrinted/Typed Name// Signature ` - Month Day Year <br /> Is <br /> Z <br /> w T 17. Trans orfer 1 Acknowledgement of Recei t of Materials <br /> V' R Month Day Year <br /> a'j B Printed/T pad Name Signature ..,-i <br /> NS <br /> LL a18. Turns orter 2 A=kr.-W amen,of Recei t of Mata.iali ^ <br /> O T Printed/Typed Noma Signature Month Day Year <br /> W E <br /> N R <br /> U19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> ( 20. Facili Owner or O erabr Cersification of re<ai t of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/991 Yellow. GENERATOR RETAINS <br /> EPA 8700-22 <br />