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b <br /> Stara d Colifomia—Emirunmenlol Protection Agtercy a Department of Tanc Substances Control <br /> Farm Approved Ouse No.2050-0039(Eapim 9-30-991 See Instructions On back o age 6. ' _� <br /> ' Plrxlu print or type. Form dnigrsd for uw an elite(12-pikhl'11p�reriM. s �/ Sacramento.Califomio <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page I Information in the shaded areas <br /> ir UNIFORM HAZARDOUS a not rpuired by Fderal low. <br /> WASTE MANIFEST ? P .' o +� i "7 2 G G 1 of l yrt <br /> -3. Genwpbls Name and Moili Ye fi,f <br /> CARL \ FvP�ikCr �Cr VK1 <br /> ct• .ar' { <br /> ven <br /> i d. Generators Phone I c i I r { f ,'c >+ <br /> N <br /> lV 5. irampaner I Company Name 6. US EPA ID Number C t"! r t .�sC x; •.:: <br /> N <br /> D <br /> G1-L•-� T.:...+_ cl-•. ,"«.-. T ... } ,' '— S c � (� 7 1 <br /> m 7. Tmmporu r 2 Company Name 8. US EPA ID Number T aN <br /> a <br /> V 9. Designated Facility Name and Sita Adds.. 10. US EPA ID Number - <br /> i;r.T a • qnt <br /> QE"'jkc-, 7:-, <br /> CD� Z'i: Yes-L rs.. l K FaclliV.Phone <br /> (M0 n.c,..,u.. ) 'r• c- I Gr: ] - G /. - b '.TiS'-13ai <br /> Na 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. natal I d. Unit <br /> �V No. Type Quantity WI/Vol I. Waste Number <br /> rjO74 gc.u'\ 1-1.17.�a]Cs.l wssCE 5< <br /> tote rr✓ <br /> I— <br /> � EPA/Other <br /> �3 G wati-rE Ew�Tv 'irT=l.xCy T.u- 1 C c. Z. <br /> ' E b slate <br /> • co N n <br /> m E —I EPA/O her <br /> N R <br /> Zq A Ste, <br /> o r fit) <br /> O J ( EPA/Other <br /> R <br /> d. <br /> Z <br /> State <br /> W EPA/Oche, <br /> !� L IiddBwrial Dessifpligns,fw 1LfedAbiin r:. ,N * W Aha. �oS Wwbs G'sAed Above <br /> { <br /> ( �{ry�1's r6.. .,. t •7 iA.l � .,Y�2 �,,.Aj�, a 't'°�trj`� ('r 1 <br /> -. •�'' {�� ' a.-. :x' ;d.^�r -r`�sl::� ehy�a"w,„,sM.s�.�w �we.V : ¢., <br /> a C ll' eS�15', tt tu�ltghPJE7hj . <br /> Q15. Special Handling Instructions and Additional Information <br /> s <br /> _.:.u[ A. <br /> Z <br /> W <br /> N Hc.E tr£..cv cs. —,c— cc.e r.�� 4. ' tic)-T�_ ,Tawe r_ <br /> c= r <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this cormgnmentare fully and accurately described above by proper ship mg name and are classified,pocked, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and notioaPgavernment regulations. <br /> If I am o large quantity generator,I<artily that have a program in place N reduce the volume and toxicity of waste generated to the degree I have determined to be xxm..it,bIY <br /> d practicable and that I have selected the practicable method of treatment,storage,or disposal currently available N me which minimizes the present and future threat to human health <br /> and the environment;OR, if I am a small quantity generator,I have made a god faith effort N minimize my waste generation and select the best waste management method that is <br /> a available to me and that I can iford. <br /> O <br /> y Printd/Typed.Name., SignaN� �. Month Day Year <br /> Z _ <br /> 'L T 17. Transporter I Acknow ed amen of Receipt of Materials <br /> Al Priarod/Typd Name / Signature r Month Day Year <br /> W p <br /> W 018. Transporter 2 Acknowled em mt of Rxei t of Maronals <br /> O R Printed/Typed Noma SignaNre Month Day Year <br /> T <br /> W [ <br /> N p <br /> kaj 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner ar Operator Cemficarion of rani t of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typd Name Sign.mre Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(A/971 Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />