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r <br /> e-of Califomio—Er ironmenlal Protection Agency <br /> en Approved OMB No.2050-0039(Expires 9-30-95) See Instructions on back of e 6. Deporrmem of Toxic Substances Control <br /> x-e pri+or ty,x. Form designed for use an elite(12pif fi) SacramgMo,California <br /> UNIFORM HAZARDOUS 1. Generators US EPA ID No. Manifest Document No, 2. Page 1 information in the shaded areas <br /> t is not required by Federal law. <br /> WASTE MANIFEST of <br /> 3. Generators Name and Mailing Addressto <br /> rr=:M <br /> 10 4. Generators Pham ( } <br /> G] mss: <br /> 0 5. Transporter 1 Company Name 6. US EPA ID Number `�-" <br /> a0 -14 <br /> .. <br /> I I <br /> J <br /> q Q 7. Transporter 2 Company Name B. US EPA ID Number `. ' <br /> •/� ��,, a�"-,fie <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> iA U 12. Containers 13. Total 14. Unit - <br /> �w� 11. US DOT Description('including Proper Shipping Name,Hazard Class,and ID Number) <br /> err Z No' T n Quant' Wt/Vol <br /> Fa' 'nSf. ' MV <br /> G '�A ' <br /> 50 <br /> oa00o N b. a5fate° �•ro <br /> C4 R <br /> A ; <br /> V d <br /> ttt ' 8v <br /> N <br /> O <br /> ?ate " ? E ..r <br /> N ' e <br /> 44 <br /> ` a ._ t t "11 <br /> O 15. Special Handling Instructions and Additional Information <br /> Z <br /> W t r , <br /> s <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignmerd are fully and accurately described above by proper shipping name and are classified, <br /> Vpacked,marked,and labeled,and aro in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> If I am a large quantify generator, I certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> J economically practicable and that I ham selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> t�/1 throat 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 Fest <br /> GG waste management method that is available to me and that I can afford. <br /> }O Printed/Typed Name Signature Month Day Year <br /> V <br /> Z 1 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> A Printed/Typed Name Signature Month Day Year <br /> ce <br /> lsr 5 s. <br /> U, 0 18. Transporter 2 Acknowledgenwo of Receipt of Materials <br /> W T <br /> Printed/Typed Name Signature Month Day Year <br /> O E <br /> A <br /> UA 19. Discrepancy Indication Space <br /> a F <br /> U A <br /> Z C <br /> I <br /> L <br /> t 20. Facility Owner or of h rdous rials covered xce as noted 1n Mem 19. <br /> T Printed/Typed Name 1 j tr" 14 5ignafure / Month Day Year <br /> Y �wu5 +e►P.L�.}k1 4 d11tS Kim GN is/zt�e$. �S NtiPY G=u►saal sr p 04 fZe4au�rao 1 <br /> %0417 <br /> Cgt.tiz�t►vt R- -�wc� a O NOT W ITE BELOW THIS LINE.A~v �s sRC..�r:rs >`e�t 5.Mu.�1V'UP-E+asnv, <br /> DTSC 8022A (1/95) White: TSDF RETAINS <br /> EPA 8700---22 <br />