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State of Calilornsa—Envhonmenbl Protection Agency <br /> Fo-i A,,mve.l OMB No.2050-0039(Expires 9-30.99) See Instructions on back a6. Department of Tonic 5ubsrences:,om <br /> Please pant or type. Form designed far use on efile(12 pach(q, ter. Sacramento,C.Gfcrmc <br /> UNIFORM HAZARDOUS I. General.,',US EPA ID No Manifest Document No. age I Information in the shaded areas <br /> i s nal required by Federal law <br /> WASTE MANIFEST <br /> 0 t of I <br /> 3. Generator's Name and Mailing Address A. Slate Manifest Document Number <br /> APR /{ 98081525 <br /> .14 4 ?Y/ 7 y a..StateID <br /> hGenera or s P one ! /" t ,7 <br /> n <br /> N 5. Tronsponer I Company Name 6. US EPA ID Number C'.Smte Transporter's ID <br /> h <br /> D. Transporter',,Phone <br /> m <br /> 7 Ty6i3TPcrter 2 Company Name 8. US EPA ID Number E.Slate Transporters ID'. <br /> QF: Tr potl 3Ph.ne <br /> V 9. Designated Facility Name and Site Address 10. US EPA ID Number G St to F I ry'z ID <br /> Q �G�Svc^ i e c o 6 ro 3 <br /> OH. Fac ty Phone - <br /> 11. US DOT Description[including Proper Shipping Name,Hazard Class,and 10 Number) 12. Containers I J. Total I d. Unit - -- <br /> IU //P'//li /"9,, P PPS^9 y No. Type Ouomiry Wt/Vol 1. Waste Number <br /> state <br /> 3 G EFA/Other <br /> C' du 1 -;; <br /> O N b' Stale :: <br /> w E 'EPA/O'her <br /> N R <br /> C A a State--- <br /> o T <br /> O EFA/Oilier. <br /> R <br /> s <br /> w d. <br /> Z <br /> EPA/Other. <br /> V <br /> st is sLI ied A6 <br /> 0 <br /> N <br /> 00 <br /> O I5. Saa<'al Ha dl I Ir <tions and PM <br /> �p rAdd'tmpa,,l f res do w! (I C 1+ <br /> UAL , -r r Orrd e �P�fI✓e G I ,t(�S / IVr a Gyt J;I <br /> a �� y <br /> Z �4 Aur- C•�s�CY ; <br /> �y rl�urPm <br /> 16. GENERATOR'S CEITIFICATIOWLArinsby declare that the contents o this cormgnment are fully and accurately described above by proper shipping name and are classified,packed. <br /> V 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 largeqonly generator,I certify that I have a pPg m in place to reduce the volume and toxicity of waste generated to the degree I hove determined to be economically <br /> a- practicable and that I have selected the p <br /> rac1 <br /> ticable method <br /> yarn <br /> storage,or disposal currently available to me which minimizes izes the present and future threat to human health <br /> w and the environment;OR,if 1 a a small quantity generator,I have mode a good faith effort to minimae my waste generation and select the best waste management method that is <br /> ac available to me and that I can afford. <br /> Oy I}jnted/Typed Nome Signature month Month r Day Year <br /> ZYY� /�t.a `�.C'' ,cl C /Jr>.•Vcl.:/!` ^/ i_:v N 0_i p I,j,r•;;J;� �+ <br /> W T 17. Trani' ner i Acknowled ement of Recei t of Materials <br /> y�j A Pmt d Na S' ur i _ Month Day Year <br /> P <br /> w S fJ d� <br /> P <br /> w 0 18. Trons orter 2 Acknowledgement of Receipt of Materials <br /> O 1 Panted/Typed Name Signature Month Day Year <br /> w P <br /> N R <br /> V19. Discrepancr Indication Space <br /> Z F <br /> — A <br /> C <br /> 1 <br /> l <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials created by this manifest except as noted in Item 19. <br /> T Primed/Ty Name Signator,./ _ Month DaY_ - <br /> Y D4V to /✓)IIYWG O 2 S I p <br /> DO NOT WRITE BELOW THIS LINE. <br /> Vh,,, 7SDF ;ENDS THS C:PY :C - - - - <br /> DTSC 8022A 1e/97) To n O Sax 7000, 3.c,.menm 7 '3•: <br /> EPA 8700-22 <br />