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51v1e of CoGia.nia—Envfronmenral Protection Agency <br /> Form Approved OMB No,2050-0039(Expires 9-30-99) See Instructions on batt, ofa e 6. <br /> Please print or type. Form ceslgnad for use on elite(12 '',I typewriter. P 9 Department of Toxic Substances Ce <br /> Sacramento,Cali <br /> UNIFORM HAZARDOUS 1. Generator s US EPA ID N. Manifest cesium Fit No 2. Page 1 striation in the shaded areas <br /> WASTE MANIFEST is not required by Federal law. <br /> ='L '." •'r- _ 17of <br /> 3. Generator's Name and Ma I ng Add ess A State Manifest Document Number n'Yfe. <br /> 98522765 <br /> -- - _ i - 8. State Generators ID -:.,q <br /> ^ 4 Ge o •s Phone - .a .- <br /> T,.n,p.rler 7 Company Name 6 US EPA ID Number C. State Transporters ID <br /> Go I:;I_ <br /> D. Transporters Phone <br /> o? 7. int s <br /> om an Name <br /> otter 2 C <br /> 2pgt5£7`' 9 <br /> P P Y 8, US EPA IW Number E SMe ns <br /> Trpporter's ID <br /> Q F. Tmnsparters Phone - y <br /> U 9'. Designated Fvc y Name and 5te Address 70. US EPA ID Number <br /> Q T I I�sl_I •i t , _ r` _ _ G. Stab Faciliy'S ID .:.P-S -. <br /> coO t _ - I H. Facility's Phone <br /> LL <br /> NU 11. US DOT Descr pM1on I nebd n Pro er Sh' 12. Containers 13. Total 14 Unit °- <br /> g p pp'ng Nome,Hazvrd Class and ID Number) <br /> NZ a No. Type Quantity Wt/vol 1. Waite <br /> U-)= t I:— '..f:=^.7SqiR•e <br /> � [lri7 <br /> 3 GI F.T,C q jl <br /> /WT <br /> �> E EPA/".2, aM': <br /> N d - "' <br /> m E Stab t z7 <br /> A EPA/ <br /> 34W <br /> pw O Statex •x ,a,;rn,3tit <br /> EPA/Other .- <br /> WM <br /> d. p'i,'t. <br /> Z stab <br /> U r <br /> e <br /> w EPA/OIMr4 r �;�- <br /> J. Additional Descriptions for Materials listed Above <br /> Z K. Handling Codes for Waihs listed Above <br /> 0 TANS' BOTTOM WASTE a' � b <br /> RINSATE <br /> aq <br /> QQ a,. <br /> 75. Special Handling Instructions and Additional Inrormation <br /> H SCC E <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> U marked,and labeled,and are in all respects In proper condition for transport by highway according to applicable international and national government regulmlons. <br /> HIIffrI am a large quantity generator, I certify that I hove a program in place ro reduce the volume and toxicity of waste generated to the degree I have determined ro 6e economically <br /> vnhe enable and than hove elected the practi<abie method or treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> and the environment;OR,ifsI am o small quantity generator,I have made a good faith effort to minimize to me my waste generation and select the best waste mono gement method that is <br /> Q available and that I can afford, <br /> g men <br /> Z Printed/Typesd�Name / i -; Si oarure ,• ''- ^f Month- Day <br /> (� R 1I Transoorrer 1 Acknowlea' mecei t eent of Rof Materials ` / <br /> wA Printed/Tybed Name - <br /> R Signature•; 4�� Mon1A Day !JYear <br /> P <br /> s+- 0r19 <br /> Tmnsborrer 2 Acknowledvemenr of Recei I of Materials <br /> T ed/Typed Name Signature r <br /> h E g" Month Day Year <br /> Q R <br /> U F i Discrepvncy Indlcatom Space <br /> Z A <br /> C <br /> L <br /> I20. Faudv Owner or Operator Certification of reriels receipt of hazardous matcovered b this m nif<sr exce r os anted in uem 19 <br /> YPrinted/Typed Nome Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A 14/97) <br /> EPA 87CO-22 -`- <br />