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Sire el Calihmio--En.iromnanld Protest.Agency See Instructions on back c / 6rtment of Task subaames C, <br /> Form Appr•-ed OMB No.2050-0039(Expires 9-3096) J . De Po <br /> Aeose print w type. Form designed for use on efih(12pfrth)ypeworter. �S Sacramento.California <br /> UNIFORM HAZARDOUS Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST �) Ci�� • is not required by Federal law. <br /> L02 of <br /> 3. Geeeroro No d Nding Address A. State Ma ifest Document Number <br /> /N�(�Si, mp�yiJl�yl� f 9 6 8 44 6' <br /> NP:i,(� X �JJ 79 ///C �g 1 s gtKr <br /> n ) v % t 70 B Storto C neiator's ID - <br /> 4. Geruraror's Phone S ) Z4 I .I _ <br /> S. Trmsponer I Company Name 6. US EPA ID Number C 'State Tmnspoder'x ID <br /> .- <br /> Q0 _ <br /> zIG 5 1 ( n D Tronspor'er's Phone <br /> T (, <br /> Q 7. TrairItfrter 2 Company Name 8. US EPA ID Number E State Tranxpoite(s ID <br /> U F. Tmaiapo rt r's-Ph«re -_ <br /> Q State Fwl <br /> Z 9. Designated Facility Name and Site Address 10. US EPA ID Number G. rIDoY , <br /> Qc <br /> :Cho 009 Fib g <br /> Fac�lay Phones� <br /> Q <br /> U 12. ContainM . Total 14. 0 t <br /> Z 11. US DOT Description(incbdI ing Proper Shipping Name,Hazard Class,and ID Number M. <br /> T ta / r <br /> uanY W' Vol <br /> G�OGO ems- <br /> c E <br /> to N Is. ate' <br /> v RUFP <br /> d A <br /> O T C. res,4 <br /> m <br /> R — _ <br /> z <br /> U <br /> z C- �1CLf 4skd-AC> _ <br /> A ( x fouT.lat9nalx YaT dbove 3 i r v..., +p w- <br /> s f -� <br /> O 15. Special Handling Instructions and Additional Information Com, <br /> 7 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the conemess of this consignment are fully and accurately described above by proper shipping name and are classilled. <br /> Q packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable interma"onal and notional government regulations. <br /> U <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 <br /> decommically practicable and that I have selected the practicable method of treatment, storage,or disposal currently available to me which minimizes the present and future <br /> N threat h human health 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 <br /> y, wash management method that is available h me and that I can afford. <br /> O Pteded/Typad Name ) Sig ne Momh Day, as- <br /> r I <br /> Z 1 17. Tronsportm,1 Acknawled emend of Recei of Malermle <br /> ILI A Prkthd/Typed a Signan,r Month Day. <br /> " <br /> W S ! � <br /> v <br /> sig 0 1 Trms er 2 Acknawled ernent o ei t of Materials 4;: ------ - <br /> LL T PriMed/Typed Name Si ature <br /> Month DaY YeT <br /> Q E <br /> Lu 19. Discrepancy Indication Space - <br /> Is <br /> X- ( oF <br /> Z <br /> I <br /> 20. FacilityOwrser or O rotor Certficotion of recei t of hazardms materials covered this nifest ezce r as slated in ltem 19. <br /> T Printed/Typed Name Signature ma Month Day yea <br /> Y p4ie � 16 i 2147 q - <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/95f ,c_ ,...... ... n.. .. . - <br /> EPA 8700-22 <br />