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Slate of California—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9-30-99) See Instructions on back ofpe 6. Department of Toxic Substances Control <br />Please Print or Nnan Farm designed for use on elite (12 -pitch) ty Sacramento, California <br />l <br />.kL:; i DO NOT WRITE BELOW'THIS LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />1/99 (Generators who submit hazardous waste for transport out-of-state, <br />DISC 8022A <br />I ) '.produce completed copy of this copy and send to DTSC within 30 days.) <br />EPA 8700-22 <br />Generator's US EPA ID No. <br />Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />UNIFORM HAZARDOUS <br />is not required by Federal law. <br />WASTE MANIFEST <br />ri. <br />9 1• B ? <br />S Z? <br />1 of 1 <br />3, Generator's Name and MailingAddress <br />A States Manifest Document Number v.. . <br />3� <br />?,lane GET I. S, iRG., im. <br />N <br />41511. may DR. <br />B. State Generator's ID <br />i <br />4TRACY, Phone4=8T f <br />"V !'A -4b?$ . Caritg;:L: ,.Bh'B D B?EL <br />5. Transporter I Company Name 6. US EPA ID Number <br />C. State Transporter's ID [Reserved.) <br />SIC F�IYiR(ABENf31 TEMD! A S 8 9 9 <br />5 a <br />D. Traaspa er's Phone S}"s�& 16 <br />7, Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID [Reserved] <br />- <br />F. Traasporter's Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />Role EIViR} ru TEO <br />e A D 3 E a <br />5 i• <br />„H. Facility's Phone Mi s <br />ill S!':L'A"6 <br />ST PILA AL <br />- <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />No. <br />T -pa <br />13. Tocol <br />Quantity <br />14. Unit <br />Wt/Vol <br />I. Waste Number <br />a. BB&`RCR! @!ZlRiB85 VAM, LIBIIID <br />State <br />LGA <br />EPA/Other <br />G <br />P '99 � 393 ERG! <br />019 ) <br />Q <br />L^ <br />N <br />6. 9UB- itAZ�.RP,CItS SAME( lulawo <br />State <br />E <br />.tB t"RtSFL? &YEBLS <br />EPA/Other <br />R <br />- - R'�ai! . p�B <br />... <br />n <br />V 0 <br />t <br />/S <br />1 SJ 0 <br />(yr'� <br />'s.✓ <br />'xo tsk <br />Ac. <br />T <br />go-Rm HIi:�RLMiBS VAS I�VM i3 <br />sate <br />r; <br />MOST!^S'n., .CL�dJn B?L? <br />EPAOther - <br />R <br />- . S - <br />� <br />V O _TI <br />s -V <br />(J I <br />i <br />d. <br />State <br />' <br />EPA/Other <br />J. Additional Descripfions for Materials listed Above <br />K. Handling Codes for Wastes <br />Listed Above <br />h. <br />d. <br />15. Special Handling Instructions and Additional Information <br />10 <br />T6. 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 />in far transport highway according no app lmoble international and national government regulations. <br />marked, and labeled, and are in all respects proper condition y <br />IF I am o large quantiy generator, I certify that I have o program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br />and that IUs selected the racticable method o! treatment, storage, ar diiposal rrently available to me which minimizes the present and future threat to human health <br />practicable <br />the OR, if I a mall quantity generator, I have mode a goad faith effa <br />o minimize my waste generation an�selecF thebest waste management method that is <br />and environment; <br />available to me and that I can afford: d' <br />n <br />Priint}ed/ yped Namej <br />Signature <br />- ..i' <br />orf Day or, <br />L <br />r <br />l/ <br />Vt> 1r. 4/enr r P-1 <br />1 <br />17. Trons orter 1 Acknowledgement of Receipt of Materials ! !v <br />i <br />R <br />p <br />Printed/Typed Name Signature � <br />_ <br />Month Day Vea <br />J r �0 <br />P <br />DAVID G,)ZTKNs � .��l <br />01,F <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materiels <br />R <br />T <br />Prinfed/Typed Name ,- <br />Signatara <br />Month Day Year <br />! <br />E <br />R <br />1 <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />1 <br />L <br />1 <br />20. Facility Owner or Operator CertiFlcation of recei f of hazardous materials <br />covered 6 this manifest exce t as noted in Item 19. <br />T <br />Printed/Typed Name <br />Signature --` ` <br />Month. Day Year <br />Y <br />v4 <br />.kL:; i DO NOT WRITE BELOW'THIS LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />1/99 (Generators who submit hazardous waste for transport out-of-state, <br />DISC 8022A <br />I ) '.produce completed copy of this copy and send to DTSC within 30 days.) <br />EPA 8700-22 <br />