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State of Calif oci—Envirmirientat Protection Agency <br /> Form Approved OMB N6.2050-0039(Expires 9-3496) See Instructions on back Of e 6. Department of Toxic Substances Control <br /> pkase pdr:%r type, rpn"designed for use on efife(12-pil-61 nite, Sacramento,California <br /> I Generator's US EPA ID No. Manifest Document No. 2. Page I Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal law, <br /> WASTE MANIFEST <br /> C, <br /> 3. Generator's Name and Mailing Address <br /> WN <br /> WI) <br /> C14 <br /> W) 4. Generator's Phone <br /> 00 <br /> —T—Tr.-P-rier I Company Name <br /> 6. US EPA ID Number <br /> 0 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number <br /> Z 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> N 1111 11:1, 11111: 31! <br /> 0 <br /> t I <br /> - r.: <br /> 11. US DOT Description(including Proper Shipping Home,Hazard Clioss,crad ID Number) NO12... Tcontainers 11 T0401 14. Unit <br /> ype Quaritity Wt/Vol <br /> H <br /> �04/1 J <br /> lit <br /> E <br /> 00 N b. <br /> 00 <br /> 4 E <br /> C4 R <br /> A I'A <br /> 6 A Jim= <br /> 000 T C. <br /> 0 <br /> R <br /> 1r, V% <br /> Z d. <br /> U.1 <br /> U <br /> Uj <br /> 0 <br /> rR <br /> 0 15. Special Hand"Instrintions;and Additional Information <br /> 4 <br /> 16, GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and occurafely described above by proper shipping name and are classified, <br /> packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable internotionxA and national govemment regulations. <br /> If I am a large quantity 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 /> economically practicable and that I ficive selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> V) throw to hurricirt health and the erivirorinwrit,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 /> W I.- waste monagemem method that is available to'me and that I can afford. <br /> 0 Printed/Typed Horne Signature Month Day Year <br /> Z T 17. Transporter I Acknowledgement of Receipt of Materials <br /> 0 4" R -�Clftypes, No. Signature Month Day Year <br /> A <br /> $ <br /> F <br /> LU 0 18, Transrter 2 Ackmerit of Receipt of Materials <br /> LL- T Printed/Typed Name )cry Year <br /> 0 E <br /> R <br /> LU <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> Z C <br /> I <br /> L 20. Fw'llty Owner or Operator Certification of receipt Of hazardous materials covered by Kris manifest except as noted in Item 19. <br /> I <br /> T Prkded/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/95) Yellow. GENERATOR RETAINS <br /> EPA 8700-22 <br />