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Stateo1California—EnvronmentolProtectionAgency :; Form Approved OMB No 2050-0039(Expires 9-30-99)- 'See Instructions On back Of Page 6. Department of Toxic Substances Control Please punter type. Farm desi§ned for Use oa elite(12-pitch)," •triter. Sacramento,California UNIFORM HAZARDOUS nerotor's USI EPA ID No. Manifest Document NLw/ 2, Page 1 Information in the shaded areas is not required by Federal law. WASTE MANIFEST 1.')l ol el " i1 --11 i.j of 3 Generator's No..and M.Mr,,Address A. State Manifest Document Number .f.�.L(3' bFaJl (',il 1:1 'Y[f i. B. State Generator's ID h 4. Generator's Phone l ^1 3t.50;,tCr.]:[ N 1i5. Transporter 1 Company Name `"- 6. US EPA ID Number C. State Tronspotler's ID[Reserved.] sn m D. Transporter's Phone o t;IiCrfC} 1 .S vLVih itllL.hiGt�lll.0 us��Y9.��.. ,`I. 1 0 !'p C} t ) r': '1S 'ti1 Fy�: �1 ilaJ1,7 . _m 2. Transporter 2 Company Name y8. US EPA ID Number E State Transporter's ID(Reserved.) F. Transporter's Phone U 9 Designated Facility Name ad 511 Address IO US EPA IDN tuber G. State F aily'e ID ;t44OURCf Rt�.�W R1 "Z . , LO d0! 7 �_ r AN.;J1T,S r ("A H. Facility's Phone iA 0 . i m/ it (800) r"•I a 11. US DOT Description Proper Shipping Name,Hazard Class,and ID Numbed 12. Conrainers 13. Total 14. Unit V p lint g per ppmg No. T pa Quantity Wr/Vol I. Waste Number �w Z_ i a Smte Ci -, Other s � P { IEG, 1J.) s LLT ,ci [s 115 i. Ytl 1,e:T:if$ oN b, - _- State - m E v R EPA/Other a A' c o T State ro O _ R EPA/Other ae w d. F State Z La EPA/Other V w 1. Additional Descriptions I.,M t rials Listed Above KHandling Codes for Wastes Listed Above Z49 a w d. Z 15. Special Handling Instructions and Additional Information f`i4111XFS Br, 40 I-2000. OSHA/SADA `PRAINT:'J:' ; !r z Cfi,` USE a F';SP Aj31STi!0V %1D PSrT;. Tien f l�t'i CSL (916) 371-5747 tt /t -' 16:GENERATOR'S CERTIFICATION: hereby declare that the contents of this c 'g mens are fully and accurate)y described above by proper shipring some and are classified,packed, Vmarked,and labeled,and are n all respects in proper condition for transport by highway according to eppl cable international and nationo government regulations. J If I ce..largeq ..tit g t I certify that I h p g e place t d thevolume d toxicity of waste generated to the degree I have determined to be econom tally Hpracticable and that I h ve elected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health sad the environment;OR,ifsI o a mall quantity generator,.I have made o good faith effort tominimizemy waste generation and select the best waste management method that is O available to me and that I can affords. } Pnnted/Typed Name SignatureMonfh Day Year P V Z tss T I . Trans rter 1 Acknowl'ed t PRecei I f Materials ce R w p Printed/Typed Name; nature _ Month � R t 9 .DAY Year.. . I a 18. Trans otter 2 Acknowledgement of Receipt of Materials O R Pnnted/Typed Name Sig afore Month Day Year w E Q R V 19. Discrepancy Indication Space Z F _ A C L 1 20. Facility Owner or Operator Certification of recei rd t of hazaous materials covered by this manifest except as noted in Item 19. T P mad/Ty,,z1 Q me Si,runwrp --r }Month Day Year Y ) `�t hl.•yT9:'�tir_... ,+kr?~1,r 'r - i•L ti,Sr' F rP" •,'b ; r•+`- DO NOT WRITE BELOW THIS LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS DTSC 8022A(1/99) (Generators who submit hazardous waste for transport out-of-state, EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.)