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State of California—Environmental Protection Agency <br />F. asApprB,ved OMB No. 2050-0039(Evpires 9-30-99) See Instructions on back of ige 6. Department of Toxic Substances Control <br />se 5nnror type. Form designed for use on elite 112 pltchl, riter. Sacramento, California <br />O <br />n <br />N <br />O <br />O <br />00 <br />Q <br />U <br />MZ <br />(DO <br />�! U <br />Cog <br />�3 <br />DO NOT WRITE BELOW THIS LINE. <br />)TSC 8022A (4197) <br />EPA 8700-22 <br />I. enerator's US EPA ID No. Manifest Document No. <br />2. Page I <br />Information in the shaded areas <br />UNIFORM HAZARDOUS <br />is not required by Federal law. <br />WASTE M <br />133I.-.;- <br />of , <br />3. Generator's Name and Mailing Address <br />A. State Manifest Document Number <br />988S1632 <br />(:--' n.I .. I'!`1_lP 5' ..',: ?_.• 1-.' �r'.' _ _ "`. II <br />B. State Generator's ID <br />A. Generator's Phone <br />5, Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter's ID <br />'17 r' -'.,L _ _ - y'; 'J - Ili' .fig" <br />D. Transporei Phone <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Tr ... porter'v ID +- 2 <br />F. Transporter's Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. Slate Facility's ID <br />1 '�r,l.'• !_.- <br />H. Facility's Phone <br />p_ <br />CIE =`� � �> ~1 �,�.:..._. V - <br />11. US DOT Description (including Proper Shipping Nome, Hazard Glass, and ID Number) <br />12. Contain... <br />13. Total <br />Ouanety <br />W. Unit <br />Wt/Vol <br />1. Waste Number <br />Na. <br />7 -Type <br />a. <br />State <br />if7!'a-RCF'H NA��;r:�ll_�c id -;S''- ..ai:�l_I?n <br />.,,-r•s <br />G. <br />E <br />". <br />N <br />b. <br />State <br />E <br />EPA/Other <br />R <br />A <br />T <br />tate <br />REPA/Other <br />d <br />State <br />EPA/Other <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes for Wastes Listed Above <br />TAI'#SC FSfJTTdM WASTE <br />a. 6. <br />EINSATE <br />J. <br />15. Special Handling Instructions and Additional Information <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this contig %t are fully and accuraroly described above by proper shipping name and are classified, packed, <br />marked, and labeled, and are in all respects in proper condition fur transport by highway according to applicable international and national government regulations. <br />If I ora a large quantiq generator, I certify that I have o proggram in place to reduce the volume and toxicity of waste generated to the degree I have determined a be is Coll <br />practicable and that I have selected the practicable method aF treatment, storage, or disposal currently available to me which minimizes the present and future threat to haman health <br />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 />evadable to in. and that I can afford. <br />Prinred/Typed Name <br />Signatures,/' /" <br />Month Day Year <br />1 <br />I <br />17. TaKs Drier I Acknowledgement of, Receipt of Materials - <br />Printed/Typed Name - - -_ <br />Signature i - <br />Month - Day Year <br />B <br />18. Trans orter 2 Acknowledgement of Recei t of Materials <br />j <br />Printed/Typed Name '� <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />20. Facility Owner or O eramr Certification of receipt of hazardous materials <br />covered by this maNfesr except as noted in Item 19. <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />Y <br />DO NOT WRITE BELOW THIS LINE. <br />)TSC 8022A (4197) <br />EPA 8700-22 <br />