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State of California—Environmental Protection Agency ,I 't ' ?-i '_I <br /> Form Approved OMB No.2050-00391Expires 9.30.99) See Instructions on back oe 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite f 12-pitchf rile,. 6 Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generators US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST 11 1 of r^ <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> 25172658 <br /> "�51 7 2 h1 V V 8 <br /> ::;LKEF:NL MI Li„ G <br /> rIN )MDE <br /> J i 0 1-44)l r d:f' }L J,9 U e:; B. Slate Generolor's ID <br /> -d.Generator's Phone (`tl ) 4 ."'.14 f1 916ER991C'Y COItTACT89R 15 <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporters ID[Reserved.] <br /> sn <br /> OP lyNI VAR. 01;A- LN('. D. Transporter's Phone <br /> 0 r- T. ZI n 9In-_?71..-'j6Q0 <br /> ao 7. Transporter 2 Company Name 8. US EPA ID Namber E. Stab Transporter's ID[Reserved] <br /> O^ UNi VAR LISA INC:. F. Trans orler's Phone <br /> n ¢ L R D U J P 4tt8-935-27t}0 <br /> p U 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> V Q OLLITTIi?N E11D U':D} IE: <br /> Z 1143 It'E:NMI DY AVE IVI>:; H. Faciliy's Phone <br /> r -Fir'AGO, TN 46,; 1:: <br /> ^la_ , Pa 13 f) LI 11 1"d"? G i�1-397-29Si <br /> n Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. C. alters 13. Total 14. Unit <br /> V U No. Type Quantity Wt/Vol I. Waste Number <br /> AERO',7L:•' State <br /> ' . 1, 'R7I'+5;1, t,FSlpi;1 , iEFh NJOi-i . :. �1 3'3 . <br /> 3 G / 13 D 13 EPA/Other <br /> E b.W-N-Rr.;'RA RAZA.RD(WS NA:iTE, LIQUID fJ V ` I Stale <br /> m E (WASTE OILS) r� 221 <br /> N it (� L D 7 n U EPA/Other <br /> NONE <br /> A c.NON-Fit I: A HAZARDOUS WASTE, SC'L.F.D State <br /> 0 O'CBRTS WITH ollo /' 352 <br /> J y y EPA/Other <br /> R �11 <br /> J <br /> d.W hl-RC:RA HA.ZAPT)CW5 k7ASTF.; Sf,L.iD fE3.7P'CY' G?'r:tF.[,; stare <br /> Z N':IPt�F_Rl,'l CONTAi NI'NG INF, '?TL, 4>B :4T,AIE, 512 <br /> !i ni (I 10 r K , <br /> _� EPA/Other <br /> h J. Additional Descriptions for Materials Listed Above K. Handling Codes For Wastes Listed Above <br /> Oll.y. 10?0589AF AXROSDL CANS a b. <br /> rn llb. 0!020 98LF MIXED OILS <br /> W Ile. 0101059INS 'AASORBENTIDEBRIS CONT W RYIIROCAPZON' c. d. <br /> Ild. 01020592NS EMPTY M&TAL DRUMS <br /> Z 15. Special Handling Instructions and Additional Information WAR APYROPRIA'fE PROTECTIVE C'EAAP WHE14 RAWDLLN6. <br /> EME:RGETKY CONTACT; CWMTREC'; 1-800-424- 9:300, CALLED MAST TDF.NTIFY LUNAR USA AS <br /> Z SHIPPES'.. <br /> us PLACA.RD`; 5Y CAS4:It:R.,!3111 PPEk YF,'; , No 1+1`s/ER SiiGRATIJI•:E <br /> J 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described have by proper shipping name and are classified,packed, <br /> VQ 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 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 economically <br /> d practicable and that Rave selected the practicable method at treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> N 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 best waste management method that is <br /> a' available to me and that I can afford. / <br /> O <br /> P it / aq Signattire n % yon Da Year. <br /> sss T 17. Transporter I Acknowledgement of Receipt of Materials ' <br /> w q Pr in �/Typed Nagle Signalare - ' y ( Mon Dal Year <br /> w s r,, r la,:, - <br /> a_ 8 18. Trans arter 2 Acknowled emenl of Recei 1 of Materials <br /> O T Printad/Typed Name S�nature Month Day Year <br /> N p <br /> w E <br /> U 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. FacilityOwner or Operator Certification of receipt of hazardous materials covered b this manifest except as noted in Ilam 79. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/99) <br /> EPA 8700-22 Yellow: GENERATOR RETAINS <br />