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State of Colifomio—Enviromnentol Protection Aq <br /> Farm Ao6r-�*d CMB No.2050-W39(Expires9,W96) See Instructions on back ge 6. f Department of Toxic Substances Control <br /> Please print-m". Forni designed for use on elite(12-pikWriter. Sacramento,California <br /> 1,. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal taw, <br /> WASTE MANIFEST Of <br /> N <br /> 3. Generotor's Name and Mailing Address Tgp <br /> 4- <br /> qn 2" <br /> 04 <br /> tn A, Generator's Phone A:?: <br /> C9 <br /> 0 5. Transporter I Company Name & US EPA ID Number <br /> MR, <br /> 7, Transporter 2 Company Name 8. US EPA ID Number <br /> 9. DesigngTed Facility Nome and Site Address 10, US EPA ID Number <br /> 0 <br /> :3 <br /> �1 iLE <br /> Tota <br /> 11. LIS DOT Description(including Proper Shipping Name,Hazard Clam,and ID Number) Contairsers I& l 14. Wit <br /> No. Type Quatr* <br /> Wt of <br /> !-b <br /> OEM <br /> I <br /> G r <br /> C4 E <br /> 0 <br /> Go N b. <br /> E <br /> C4 R <br /> 6 A <br /> 0 T C. <br /> 00 <br /> 0 <br /> 21 -- AN <br /> Uj <br /> t- <br /> Z cl. <br /> W <br /> U <br /> W <br /> d <br /> 0 <br /> C <br /> LLJ <br /> W <br /> 0 <br /> gliilill <br /> Z . - <br /> 15. Ssped.1 6 Imptivc6cm and.Additional Information <br /> Z <br /> 1.6. GENIERATOR'S CEIMIFICATM: I hereby declare that the contents of this consignment ore fully and accurately cle"becl above by proper shipping name and ore classified, <br /> -cc packed,marked,and labeled,and are in all respects in proper 6onditiork for transport by highway according to applicable international and notional government regulations. <br /> If I am a large cluarift 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 <br /> Q. economicallyeconomicallypracticable and thatI ham selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> to threat to human health 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 <br /> vmft mc"ement method that is available to me and that I can afford. <br /> 0 <br /> Signature Day Year Printed/Typed Name <br /> Z T 17. Transporter I Acknowledgement �,f Fi; Its <br /> Us Month Day Year <br /> 0 A Printed/Typed Name Signature <br /> Uj 0 IS. Transporter 2 Acknowledgement of Receipt of Materials month Day Year <br /> Printed/Typed.Home Signotvre <br /> 0 E <br /> it <br /> Uj <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> Z C <br /> I <br /> L <br /> 1 20. Facility Owner or erator Cersificcrtion of receipt'of hazardous materials covered b this manifest except as noted in Item 19. <br /> T Printed/Typed Name SIqrX*VM Month Day Year <br /> YL— <br /> DO NOT WRITE BELOW THIS LINE. <br /> DISC 8022A (1/95) Yellow: GENERATOF KTAINS <br /> EPA 8700-22 <br />