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ironmental Proetion AgncyilbmCalioo—BnNv.2050- 039(Expires 9-30- <br /> 99[yofpprovmOMSea Instructions on back of pDeportment of exit Substances Control <br /> 'lease print or type. Form designed far use on slile f 12-pitch)tySacron .to,California <br /> . Generalor's US EPA ID No. Manifest Document No. 2. Page 1 Information in d. shaded areas <br /> UNIFORIA,HAZARDOUS > s no,required I. Federal law. <br /> WASTE MANIFEST ( of/ <br /> A. Stove Manifest Document Number 534475 3. Generoter�ame and Mailing y�dress T .s� 1^s A �3 p A ^� <br /> �"pl���,,(s1�e` ..11,A,tt � +�-QC.i C:;, f 1 L 4 J e't�i 1. <br /> r/ >��t......}j, t }CCC:yyllB. State Generale,'.ID <br /> her <br /> V 5. Transporter I Company Name o. US EPA m Number C. State Transporier's ID[Reserve .] <br /> 0 D. Tronsporihn s Phone <br /> 7. Transporter 2 Com ny Nama 8. US EPA ID Number E. State Transporter',ID rReserved.1 <br /> F. Transporter s Phone <br /> J <br /> 9. Daaigna Facility Name and Site Address 10. US EPA ID Number G. State Facilit/s ID <br /> lKv !Cx T4AL, <br /> z DC7 1 ,� ��1 H. Facility's Phone <br /> L T T G. 0 1 -,�S/ - � � 41 <br /> 12. Containers 13, Total I4. Unit <br /> tL <br /> J 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No T Quantity WI/Vol 1, \'rile Number <br /> L a Sta t. <br /> e r <br /> EPI 101hec., <br /> I <br /> E sm . <br /> � N b. <br /> a E EN/Other <br /> v R <br /> a A SK <br /> T <br /> X) O EP1/Other <br /> R <br /> Y SIC <br /> _u d. <br /> Z <br /> y EP.i/Other <br /> J <br /> y <br /> n <br /> J. Additional Description.for Materials listed Abav Jr.� K. Handling Codes for Wastes Eisrsd Above <br /> i I)V�— n L -1 OIU� t c �7 h ` b. <br /> n <br /> y ti � G <br /> z a d. <br /> Z <br /> 0 15. S ial Handling Instructions and Additional Information <br /> > /�fz f it ���2:� -� �, C. tIf fCrai {A�!� � lo`t) h04 <br /> P — 7 (sty ) �f <br /> Z J <br /> 01-1441* <br /> 16. GENERATOR'S CERTIFICATION: Thereby declare that the content of this consi nmeIF are Fully daccurablr described above by proper shipping name and are clot ified,packed, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport y highway according to applicable international and nationaPgovernment regulatio,s. <br /> If I can a large quantity generale,,I certify That I have a pro <br /> ram in place to reduce the volume and toxicity of waste generated to the degree 1 have determined o be aconomicollY <br /> d practicable and that 1 Kava selected the practicable method of"cement,storage,or disposal currently available to me which minimizes the present and future thri st tohuman health <br /> and the envirow as <br /> nment;OR,if I am a small quantity generator,I homade o good faith effort to minimize my waste generation and select the best waste manager gent method that is <br /> z available to me and that 1 can afford. <br /> OPrin Typed Name Signaty : Month -„r)ayJh,w Year <br /> w T 17. Trans iter Acknawled eme 1 o Receipt of Materials <br /> zj 0. Printed/Typed Name –. Signahre �r _ Month Day_ Yw <br /> P <br /> Wp 18. Transport.,2 Acknowledgement of Receipt of Ma aria). <br /> 0 T Prynted/Typed Name Signature Month Day Year <br /> a T I I <br /> � 0. <br /> V19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> 1 <br /> rr.] <br /> acili Owner or O rmor Certification of recei t of hazardous materials covered this manifest exce t as noted in Item 19.7 d/Typed Name Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A 11/991 Yellow: GEt•ERATOR RETAINS <br /> EPA 8700-22 <br />