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State of California--Environmental Protection Agency <br /> cam' (4JU(r q 0 <br /> Form Appr�'%4 0A0e!o.2050-0039(Expires 9.30.99) Se@ Sh/��h n"" QC�C O e 6. Deportment of Toxic Substances Co"trol <br /> Please pri'6 yr type. form designed for use on @Iiia f 12-pihh ilar. s r `-T Z] Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generators US EPA ID No. Manifest Docurnani No. 2. Page i InFormalion in Iha shaded areas <br /> WASTE MANIFEST Q g $ t C1� C1 �'• aF is not required by Federal taw. <br /> 3. Generators Name and Mailing Address` /y Q/ A. State Manifest Document Number <br /> /4777 2433 °952 <br /> 0 � 9 ;33�3 Q S. State Generators ID <br /> N d. Generator's Phone �A }gs9' 7_;;11 A V. MART D �fS 1 N + <br /> N 6. US EPA ID Number C. Stole Transporters ID Rase .I <br /> LO <br /> o SRRVTCBS CAD 9 8 2 4 1 3 2 62 D. Transporters PhoneQT ` <br /> 7. 8. US EPA ID Number E:State Transporters ID Reserved.) <br /> RAMIATINC_ CAD063547996 <br /> � ° F. Trdrisporter's Phony <br /> aLL <br /> ry V n e are Address 10. US EPA ID Number G, State <br /> a 2{195 N�NI]S DRTVg RAST >! <br /> 7� SLY, NV 899.08 N V D 9 8 0 8 95 3 3 B k• Facility's phar 5 RQ <br /> t� <br /> 0 <br /> tJ <br /> 11. US DOT Description(indulin roper Shipping Name,Hazard Class,and[D 12. Containers 13. Total 14. Unit Number) No. T QuGnti Wi/vol I. Waste Number <br /> Z ° 'so/ dG ` slat@ �- <br /> 3 G y I( J>1M10101VP0P <br /> EP �1�+�' <br /> /e <br /> State <br /> o N b' <br /> w E LEPA/Other <br /> 4 R <br /> C44 A t <br /> o state <br /> T <br /> co 0 EPA/Ot4 or <br /> R <br /> LU d, <br /> state <br /> w EPA/Other <br /> LLJJ�1ddilianaI pfions#gv Materials Usted Alior✓! hl n r� i"�,4 �.M ';�Z'`e r K. Hdndling Codes fpr Wastes Listed Above <br /> � ,� �' ' nk��,i� Q.�• , ., .,. <br /> 0 <br /> a �i r' i pz 3�T-f' s;y'h^y . �• e:y r XA <br /> y ssr 'w{t M' '�F, ) '�1i !'" �i G. �Y t F i,•(,y •R r ,y��dc d.1*' ( 'A h Al r, <br /> Q '1i 1raW 14,{il�:.��dti A •.,l -M1 1'S�"'f, v�m•ter~ :�:J� 'L�!`''W'R���- .il+- '4f-"��,"4 .k.�i. ,Y�ci�� ' <br /> Z 15. Special Handling Instructions and Additional Information " <br /> 0 <br /> 11.a,. /7 1 <br /> Z 24 WFtmCy ODNTACT_/--ADO -'56 7. 7`/S:S7-- Mi- <br /> lk- <br /> WEAR PR0n=IVR CLING & EYRWRAR SM: lid- <br /> 16, GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment ore fully and accurately described above by proper shipping name and are classified,pocked, <br /> La.1 marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> IF I am a large quantity generohx,I certify Iha't(have a pro <br /> ram in place to redoce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> a- practicable and That I have selected the practicable method o!treatment,storage,or dispos currently available to me which minimizes the present and future threat to human health <br /> and the environment;OR,if I am a small quonfity generator,I have mode a good Faith inimize my waste gonerolion and select he best waste management method that is <br /> ac available to me and that I can afford. <br /> OPrint / ped Name f Signatuu a _ / h" Day T ooj <br /> Z fl ,'(� �I, C , q G . i4 i .� <br /> sss 1 17-4ronsporl cknowled ement of Receipt of Materials <br /> Uj R <br /> sN A Printod/T me / Signa <br /> *nth Days <br /> su S <br /> 101-1.51 / U <br /> P <br /> si p 18 runs rter 2 Atknowled vment of Receipt of Materials <br /> O R' Printed Name Signatu _ Mont <br /> LU <br /> E` Dp <br /> R <br /> V19. Discrepancy Indican Space <br /> Z F <br /> A c <br /> C <br /> I <br /> L <br /> ( 20. FacilityOwner or erator Cert'ficoti of ei t of hazardous materials cove this manifest axce os not rill t6m Ili. <br /> T ,Pr Typed Name /I ( Sig dturo Month Dny� �lyea�} <br /> Y ,, ) <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> (Generasors <br /> submit hazardous <br /> transport <br /> t <br /> OTSC 8022A(1/99) produce completed copy of this copy and sendoDTSC within 30 days.) <br /> EPA 8700-22 <br />