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State of California—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9-30-99) See Instructions on back of <br />Please or type. Form designed for use on elite (12-pifch) yp - Pgh6• Department of Toxic Substmcez C- I I <br />-" DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) <br />EPA 8700-22 Yellawt GENERATOR RETAINS <br />UNIFORM HAZARDOUS Gen -rotor's US EPA ID No, <br />Sacrament-, California <br />Manifest Document No. 2. page 1 Information in the shaded areas <br />WASTE MANIFEST <br />��' 1 -f 1 is not required by Federal law. <br />3 Ge eratar.'s Name and Mailing Address <br />,j <br />PAPIFT+; CZAF H.S. I..B.P IHC. <br />41041 H. HOLLY DR. <br />A State Manifest Document Number �., . p R r <br />g ' a <br />h <br />T -ba, CA �w+ 3 <br />r v , <br />B. State Generatols lD - - <br />J. Ganeratoiz Phone I t1.i6"%44 1'.t1Nt.31.`t.k ,]M r]ARYC3, <br />- - - <br />5. Transporter Name 6. US EPA ID Number <br />C State Transporter's ID [Reserved.] <br />act <br />itl��C��oemnpany <br />r'�YIR1 FITAL TECH. A 9 4 <br />5 2 6 5 1 <br />p'.'d?lc <br />A 9r} <br />D. Transporter's Phone h <br />m <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID [Rererved.l <br />Q <br />V <br />F, Transporter's Phone <br />9. Designated Facility Name and Site Address 10. U5 EPA ID Number <br />G. Stale F ry's ID - <br />a <br />PUNIC EVIHOWITAL TFM <br />d4 <br />A <br />O <br />s ti T 4 9 4 <br />PAWAL 511, -Ari :,-K <br />5 2 0 5 <br />H. Facility's Phone <br />J11 <br />US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />74. Unit <br />Type <br />Z <br />41_41_ <br />a. "' , A _ ASO Ll� ti+ <br />Na. <br />Quantity <br />WIN -1 <br />I. Waste Number <br />4P£TROI q8I OIL] ' <br />Stam <br />_ <br />1 - <br />i <br />Ca <br />E <br />_4141. ?`Till E 3AIM3 90 <br />-la . <br />p <br />p�/y <br />F ' <br /><J <br />EPA/Other, <br />D <br />N <br />6 ea.. "n cin, ai'� x <br />f. <br />hs <br />t'OLtffWj&LYO <br />state <br />o <br />i� <br />a <br />r <br />R <br />A <br />- -- - 4141.-41 41 ...- FW14 S 3$1287 MIBd <br />+ <br />,j <br />�• � <br />.EPA/other <br />'qtr !h .7 6s SOLID <br />Il &R}f'd R.i?tIBSYPAB$, a"M"}tflLI31H amf,/'k� <br />a r <br />sr re <br />o <br />O <br />7_^, <br />- <br />R <br />3 91 .s <br />1 <br />t�� l <br />)/'� <br />EPA/Other <br />d. <br />SAO <br />i B <br />P <br />VP4 - <br />_ <br />state <br />EPA/Ot6ek <br />J. AddtlianalDezcnptions for Mater cls Listed Above <br />R. Haadling <br />Codes for Wastes <br />Listed Above <br />4141 <br />d. <br />[ <br />15. Special Handling Instructions and Additional Information <br />i1d!i5. IIOGlt t 4+�;L 0412,LL ,so„ <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contenH of this consignment are fully and accurately deecri6ed above by proper shipping name and are classified, packed, ' <br />marked, and labeled, and are in all respects in proper condition For transport by highway according to international <br />applicable and,national government regulations. <br />If I am o large quantiy generator, certify that have a paooggrace in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br />practicable and that I have selected the <br />practicable method of freatment, storage, or disposal currently <br />and the environment; e and OR, if am a small quantity generator, I have made a good hiih (fad t <br />and table to and that I can afford <br />available to me which minimizes the present and future threat to human health <br />minimi. my waste generation and select the best waste management method that is <br />Printed/Typed Name Signature <br />�,,r <br />•--e.., <br />,�-•-.�y"AW % Montthhy Day? Year <br />�w,_��'_. <br />T <br />Trans 4141 / G� 1 L -4141) <br />1 <br />17. ode', l A'Knowk f-MdtSrials <br />�.. <br />R <br />8 <br />5 <br />�l3Ano <br />Printed/TypeSd,A�Jam9(�_ p y ! -- Signature �,. <br />Mont Do Year <br />P <br />\r•• -+mw Ger <br />8 <br />18. Trans r{er 2 Acknowledgement of Receipt of Materials <br />7 <br />E <br />Printed/Typed Name <br />Signature <br />- <br />Month Day - Year <br />R <br />19. Discrepancy Indication Space, <br />R <br />A <br />C <br />E <br />1 <br />20. Facili Owner or O orator Cerfificafioa of recei t of hazardous materials covered b this manifest <br />except as noted in Item 19. <br />YPrinted/Typed <br />Name <br />Signature <br />Manch Day Year <br />......... +1tuc3sm^ <br />-" DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) <br />EPA 8700-22 Yellawt GENERATOR RETAINS <br />