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SIU*of Califemia—Emironmentd Prix se: on Agency, <br /> See Instructions On back C 7ge b. Department of ToTo...Substance-Control <br /> Form Approve(LOMB No.2050-0039(Expires 9-30-991acramento,CaliforniaCiFor <br /> Pldou print or l". Form designed For.on miser � <br /> 112-ism: rb <br /> ir. \./ I <br /> 1. Genemlor's US EPA ID No. Mlanilest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS a no,regofred by Federal I. <br /> WASTE MANIFEST ! r cl I jiloijI EJZ 1x x i 1 ? I I Ial <br /> 3. Camerarols Name and Moiling Acidrees <br /> L k' P It p <br /> vi A. Gmerarols Phone[�',-'/) <br /> n <br /> H 5. Trarsspme r I Company Name 6. US EPA ID Number CP9ooYFm.pw✓e III , <br /> p ISE., .\ r- .'Ik>? 'fl3C4 7-Str/c <br /> m 7. Transporter 2 Company Nama 8. US EPA ID Number <br /> U 9. Designated Facility Name and Sine Address 10. US EPA 10 Number G- Stat.Favi YID - <br /> 4F*2 [T '`cu•> H. Facdlys Phone <br /> of <br /> .CA Z,3S-1313 <br /> MQ s 12. Contain... 13. Total 14. Unit - <br /> V 11. US DOT Description(inducing Proper Shipping Name,Hazardm <br /> Class,and ID Nuber) No Type Quantity Wt/Vol I. Waste Number <br /> rig a. ;.4"tj j<CkL% 1-f.a7A4;3Z c a.:v`•T L,l State 1,L <br /> LO EPA/Other <br /> w3 G u.nYrf W?^/ Sr.�c: 17.5-Its -.r Z•- <br /> a)o N 6 State .. <br /> Go E EPA/OO. - <br /> a R <br /> e A a Sone <br /> o T <br /> m OR A / EPA/OII»r <br /> W d V sme- <br /> Elt"�` r r <br /> W ». <br /> Z 15. Special Handling Instructions and Additional Information <br /> H IC£f�AwY�wM ii.CCC c" tC -,� ,:,�s,-..,v, _..c�. Hs•7M.�:t, c.iutT. wc..kn�C, s.�..l �.S-t <br /> Z <br /> Z i <br /> W <br /> � V HI. E.M(Z[,E,,.ey Co...—ti; �3Ex> T?..e� Eaw,� (e;r1�^Z.7—S.`K= GAS Tc3 5 •'•: wc. i <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment aro fully and accurately described above by proper shipping name and ore classified,packed, <br /> < 'marked,and labeled,and ata in a8 respects in proper condition for transport by highway according ro applicable international and national gorn <br /> vement regulations. <br /> If I am a large quontiy generator,I certify that I have a p ram in place to reduce the volume and toxicity of waste generated In degree I have determined to 6e scants oily <br /> �- practicable and that I haw selected the practicable mn <br /> method ? eam <br /> tmp a <br /> storage,or disposal currently available to me which minimizes the present and future threat to humn health <br /> N and the enviranmmY,OR,if I am a small quantity generamq I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> available to me and that I can afford. <br /> O} Printed/Typed Nape Signatures Month Day Year <br /> Z <br /> W T 17. Trans r er 1 Acknowledgement of Receipt of Materials <br /> It <br /> Printed/Typed Name Sigpature Month Day Year <br /> W E <br /> W 018. Transposer 2 Acknowled emenr oI Receipt of Manorial, <br /> O i Printed/Typed Nome Signature Month Day Year <br /> W [ <br /> N R <br /> vC <br /> U 19. Dimreponcy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> ( 20. Facili Owner or O .rater Cert fissim n o1 recim t of hazardous materials covered b this manifest esce t as noted in Item 19. <br /> T Printed/Typd Nama Signatum Month Day Year <br /> Y I <br /> DO NOT WRITE BELOW THIS LINE. <br /> GTSC 8022A(4/97) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />