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S, of Cal�Env onrenla�roen ton germ, � <br /> Form Appro OMB No 20$0-00391Ezptrei 9-30-991 See Instructions On back OF Page b. Departmentof Toxic$ubstances Control <br /> Please pr e., Form designed kr use on.1,1112-pikhJ 'ter. Sacramento,California <br /> F 1. erator's US EPA ID No. Manlfeet Document No. 2. Page I Information in the shaded areas <br /> NIFORM HAZARDOUS is of required he Federal lay <br /> WASTE MANIFEST <br /> a � <br /> 3. Generator's Name and Mailing Address A late'Manifest Document Num6er <br /> O 3301 N.Navom Road Stockton s CA S6206 B. State Generator's ID <br /> srt A. Generator's Phone ( 208031-1277 AAn: -- ' <br /> n <br /> N 5. Transporter I Company Name 6. US EPA ID Number C. State Transporters ID[Reserved.I <br /> U71 <br /> 00 <br /> Opper�W$ <br /> SlkVf0MUnIld SWvk@s D.Transporter's Phone 16 ' <br /> 5747 aD 7. Transporter 2 Company Name -31`1 <br /> P p y 8. US EPA ID Number E, State Transporter's ID(Reserved) <br /> naE. Trc sporier's Phone <br /> nU 9. Desi ted Facility Name and Site Address 10. US EPA ID Number G State F ty',ID <br /> a Paail�c Re Mmw RWOVWY <br /> n� 3150 East POLO Shrd. H Facility's Phone <br /> a°LL- LosAnyalas, CA NOa2S 33$78®-0078 <br /> nQ 12, Containers 13. To tnl 14. Unit <br /> U 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Oua nt.ty Wt/Vol 1 Waste Number <br /> �Z a <br /> State <br /> 3 e <br /> Waste CeombUStlble Uguid, N.O.S., NR1993, PG Ili EPA/Other 741 <br /> E Oo Dm a 11 11 1 FOW <br /> o N State <br /> E <br /> NR EPA/Other <br /> v A <br /> o T state <br /> m O <br /> R EPA/Other, <br /> C <br /> F d:. <br /> Z <br /> U <br /> Z <br /> 0 <br /> VatW <br /> K <br /> Q f <br /> Z 15. Special Handling Instructions and Additional Information _ �, /) q 7 <br /> Z HANDLERS BE 40 HOUR OSWVSARA TRAINED AND USE NIOSH APPROVED PPE. I <br /> w EMERGENCY CONTACT'(916)371.5747. cob_ Pr~ <br /> 3301 N.Nie UW Road. Sk *tDn, CA 95206 ( — <br /> . .16. GENERATOR'S CERTIFICATION: Imarshy declare that the contents of this consignment are Wlyondaccarately dessribedabove by propershipping name and are classified,packed, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> J IF 1 am a large quantiq generator,I certify that I have a-proggram in place to reduce Ilse volume and toxicity of waste generated to the degree I have determined to be economically <br /> wpracticable and that I have selected the practicable method of treatment,storage,or disposal currently available tome which minimizes the present and future threat to human health <br /> and the environment;OR,if I pm a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> O " available to me and that I can afford. - <br /> } .Printed/Typed Name - '- SignatureMonth Day Year <br /> U it r1 r' Q <br /> w T I <br /> U R 17. Trons rier 1 Acknowledgement of Receipt of Materials <br /> �j t1 n to Typed Nama tgnalur Month Day Year <br /> R <br /> W F v/ '. <br /> w e lcnowlReceiptot Materials - <br /> O RPrinted/T ed Nome <br /> T Printed/Typed Signature Month Day Year <br /> w E <br /> rn R <br /> V19. Discrepancy Indication Space <br /> Z F <br /> F <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Nome Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> t <br /> DTSC 8022A(1/99) <br /> EPA 8700-22 Yellow: GENERATOR RETAINS <br />