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StateofCoibrnia—Environmental Protection Agency x� <br /> Form APproved OMB No.2050-0039(Expires 9.30-991 See Instructions on back of ^r b, Q�� ent of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12-pitch) Sacrament,Califernia <br /> UNIFORM HAZARDOUS I. ..arab,',US EPA ID No. Manifest D«emenl No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST C C a i gg g al required by Federal law. <br /> of <br /> 3. Generator's Name and MailingAddress ` A, State Manibsl Document Number <br /> , -� g'1 5eno : IVV�57S t"n!1 C27�0�86 <br /> h �J 'Ks <br /> B. SMte Generaror's ID <br /> A. Generator's Phone A <br /> hN 5. Transporter 1 Company Name 6. US EPA ID Number T C. Store Tramportei s ID(Reserved.] <br /> m6 <br /> rG Vo 166- Vksr� 1 L C 8 a7 8 7 D. Tra., on a <br /> O 7. Transporter 2 Company Nome B. US EPA ID Number E. Slate Tren> rter's ID Reserved. <br /> O^ Po (_I <br /> QF. Transporters Phone <br /> U si op¢Fptj�i (I ayl Site es 10. US EPA ID Number G. Sia a<iJjyjsdD ^/� � /> <br /> -- U�a•J, FY� /�s`r{1!s�IPJ��'lt t e OIL /di 0 Y Y UY <br /> 'Z 1100 S . <br /> ility's Phone <br /> _ <br /> �Q CA <br /> ob q 7 H. F«sea -his 5577 <br /> V 11. US DOT Description lin<Iuding Proper Shipping Nome,Hazard Class,and ID Number) 12. Containers 13, TotalIA. Unit <br /> No. T e Quantity WI/Vol I. Wade Number <br /> Q C UIC <br /> = State <br /> � a <br /> / JQ EPA/Other <br /> 1 <br /> o N b' State <br /> GO <br /> co E <br /> R EPA/Other <br /> < A c <br /> T Stole <br /> g O <br /> R EPA/Other <br /> of <br /> all. <br /> State <br /> Z <br /> w <br /> V EPA/0th., <br /> w <br /> Z 1..Add"anal Desaiptiom F r Ma sats Listed Above K. Handling Codes for Wastes listed Above <br /> Z `9 e <br /> O O I [ h TT a. b. <br /> w _`y <br /> °C 1 c. d. <br /> Z <br /> Z ha Han m Instructions and Additional Information <br /> 100 eu <br /> Z tr5e�c c� �►'10�2 �-(c�n7-�?3�57 130 6, Chc�nt`el. <br /> s- 5 k N Q R %Z6 G <br /> Q16. GENERATOR'S CERTIFICATION: Ihereby declare that the content,of this consignment aro fully and accurately described above by proper shipping name and are classified,packed, <br /> V marked,and labeled,and are in all respects in proper condition for transport y highway according to applicable international and national government regulations. <br /> J If 1 am a large quanliy generaroq I certify That I have a program in place to reduce the volume and toxicity of waste generated to the degree I hove determined to be economically <br /> CL practicable and that I hove selected the practicable method o treatment,storage,or disposal currently available to me which minimizes the present and future threat to 6.man health <br /> and the environment;OR,if I am a small quantity generator,1 have made a goad faith effort to minimize my waste generation and,eIM the best waste management method that is <br /> a avoiloble to me and that I can afford. <br /> O <br /> } <br /> Pi n 'ped ion. M. th y Year <br /> f Al f � i/ y o3 <br /> w ; 17. Transporter 1 Aam,vied'ement of Rec;ipt of Materials <br /> W A Printed/T me Signature Month y Year <br /> W ; v o y �`FtO <br /> OR 18. Trans r 2 Acknowed anent of Receipt of Materials <br /> TPrintad/Typed Name Signature Month Day Year <br /> H E <br /> A <br /> 19. Discrepancy Indication Space <br /> Z F <br /> _ p <br /> C <br /> I <br /> IL <br /> [��*r O erator Certification of recei of hazardous materials cowered 6 this manifest exce t as noted in Item 19.T e Sighatere Month Day Year <br /> Y <br /> DO NOT WRITE PELOW THIS LINE. <br /> DTSC 8022A 11/991 Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />