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State of California—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039(Expires 9-30-99) <br />Please print or type. Form designed for use on elite (12 -pitch) typele <br />See Instructions on back of pc&6. Department of Toxic Substances Control <br />Sacramento, California <br />la=-,lxduzbE, ; E DO NOT WRITE BELOW THIS LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />(Generators who submit hazardous waste for transport out-of-state, <br />DISC 8022A f1/99) produce completed copy of this copy and send to DTSC within 30 days.) <br />EPA 8700-22 <br />1. Generator's US EPA ID No. Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />—F1FItpORM HAZARDOUS <br />; u t <br />D T "e 5 3 4 411331 <br />g <br />isnotrequiredbyFederollaw. <br />WpSTE_MANIFEST <br />D 1) <br />of <br />3.Generaror's Name and Mailing Address <br />A. State Manifest Document Number >R <br />PACIFIC M -T S.S. 1m., INC. <br />B. State Generators ID <br />4101 X: Ml y CR. <br />:'RRCs, CA CIFA <br />4. Generator's P ne (^ 7�t [e. -%2.j CantaC:• JM 0AXE . <br />5. Transporter I Company Name 6. US EPA ID Number <br />C State Tronsporter's ID. [Reserved.] r✓ <br />RMIC EVIRGVMAL TEM. i1 � 1J 4 1 2 ¢ G 7 <br />D. Transporter', Phone q s3; 4 -HI <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Tmnsporter'z ID [Reserved.] <br />F. Transporter', Phan. <br />9. Designated Facility Name and Site Address 10. US EPA ID Number -State"F.61h <br />'G. N; ID - - <br />1 _ - S <br />� 3 r <br />TECH r A q d 5 <br />H. Focili 's phone g O 11:=_1 •..T <br />iRDB��fICa01TiRORBf.'RSAL <br />Gi IV WO <br />PAST . C W.3 <br />11. US DOT Description (including Proper, Shipping Name, Hazard Class, and ID Numbed <br />12. Containers <br />No. <br />Type <br />13. Total <br />—Quantity <br />14. Unit <br />W5/Vo1 <br />I. Waste Number <br />a.21-RCRA BAL3RRwSK�E'pJ.er LIMID <br />State <br />'Ir <br />gqUwMrN, <br />112 <br />EPA/Other <br />G <br />lr^ 4 F. 341? EM <br />Ca Ole,o' <br />E <br />b 4Oii SCC+A fia jZQS ;t,4G" ZZ SOLID <br />st t <br />E <br />I°lll�i .,iii..ds ai3dp:Su�Ruaxw UL) <br />:EPA/Oth <br />A <br />��' 8 :4, <br />,+� <br />9 J . <br />.�,vv�° <br />3 <br />i;•or: <br />state <br />T <br />a. <br />EPA/Other <br />O. <br />R <br />Stole <br />I <br />- <br />EPA/Other <br />t 'K. <br />' J. Additional Descriptions for Material, Listed Above <br />Handling Codes for Wastes <br />Listed Above <br />- _ <br />b. <br />� <br />15 Special Handling Instructions and Additional Information M a ZOOM M I- '27 I E.. g <br />��'aG. MMUM", 'IrvJv 7UW �� ♦LfV�3 <br />5 k f8ot 3a"s- °toe <br />M11 72r 9F C Ieah 14x - II <br />�y <br />AAp't1 <br />l <br />rUCs <br />. e`1b,PrnaT. <br />'pj«y=A;'fr <br />Sat�9H <br />Ur ar< I'"5,2 1-17ne 9MtC <br />,.}6. <br />GENERATOR'S CERTIFICATION: I hereby declare that the contents of this const9 ent are Fully and accurately described above by proper shipping name and are classified, packed, <br />for transport by highway according to applicable international and notional government regulations. <br />marked, and labeled, and are in all respects in proper condition <br />If I am a large quantity generator, I certify that I kava a program in place to reduce the volume and toxicity of. waste generated to the degree I have determined to be economical <br />-practicable of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human Il <br />and that 1 Gave selected the practicable method <br />if I I have made a good Faith effor7 minimize my waste generation and select the best waste management method that is <br />and the environment- OR, am v small quantity generator, <br />available to me and that can afford. - ✓ <br />' <br />� <br />, / <br />Print e /T dd Name ( Signator "�" /- f' Month Day Year <br />, • ° �f Z Z p c� <br />i/ - <br />u T <br />[ e <br />17. Tr s arta Acknowled emeeMsFlieee' erivlz <br />Month Day Year <br />p <br />Printed%Type�d me (/r Signature <br />P <br />B <br />18. Trans arta 2 Acknawled emeni of Race t of Materials - _ <br />- Month Day Year <br />T <br />Printed/Type Name - Signature <br />E <br />jo R <br />p <br />1IF [9� Discrepa cyy 1ln_diccattion�.S�paace t_-�;� F� lo`,, I IW. 9 ti �� �_p9�n <br />"'iL' n''iY+lf C� It :4-i : <br />A <br />.d -�"!"� <br />i <br />eppIf <br />20. Facili Ca. er or O erator Certification of —.i,l of hazardous materials covered u manifest..ce t as noted in Item 19. <br />1 <br />T <br />` <br />Printed/.T�ped Name .. Signatures' r' -y) Month Day Year <br />la=-,lxduzbE, ; E DO NOT WRITE BELOW THIS LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />(Generators who submit hazardous waste for transport out-of-state, <br />DISC 8022A f1/99) produce completed copy of this copy and send to DTSC within 30 days.) <br />EPA 8700-22 <br />