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Of C•aMmW-4f"M w wallas Agency <br />ace iww. / o8! N9. =00-f� Qxpr« 8�.A1 <br />i.' aha <br />'a <br />m <br />N <br />m <br />r <br />2 <br />—type. Alt— 1 For bee « Tea aroewe6rI ..I `./ (NiarawtrM. Qi�a� <br />UNIFORM HAZARDOUS �"" 'err• "g �" D No.tA«86Y <br />WASTE MANIFEST tic, <br />�. 6 N6me a« Me" Addree - S� <br />mob►1- O I L <br />s. Generator's Phone ( `g) - 7 �o id 3 <br />a <br />�[ E. US EPA ID Number <br />5. Tranalpprtw I C[o�mpany N,m/ LC <br />i � I P "C.� �D D % <br />C. Stab Transporters D <br />1 <br />D. Tnuupa(ers Phone <br />aN JE.K.0 C, / I <br />m <br />7. Transporter 2 Company Nama B. US EPA ID Number <br />E 89610 Tra«portara D <br />g <br />F. Tr«eporlers Phan <br />9. Des ectad F ci ity Name and Site Address 10. US EPA ID Number <br />H H W+1 P S AAI c,E <br />G. Sate Fecilhja D <br />o <br />H. Facility's Phori. <br />94 —oqa& <br />SW I cs Qua �, AID, 0104,717, / ! <br />t 1. US DOT Doscrnptlon (Including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />Quantity <br />ts. <br />Un8 <br />1. <br />Waata No. <br />_ <br />- <br />No. Type <br />IWUv� <br />xL�! <br />z G <br />.. k* ICA 3 <br />�.t. <br />3 N <br />(Ci WI{ CEJ J p 1 v � V YD <br />i o <br />% <br />EPA, <br />V C.. <br />a <br />!Y <br />N R <br />°. <br />I <br />stere l <br />T <br />EPAEPAIOt�� <br />0 <br />R <br />C. <br />State j <br />I <br />i <br />FPA/Other <br />G. <br />Slate <br />i <br />1I <br />EPA/Other <br />J. Ad01tlgW Deaoiptions for Wterial, W' ted Above <br />K 1Wtlenp Code for area LIatW Above <br />17 <br />Q/UK <br />d <br />°cks _ <br />i <br />a <br />15. Speal dandling matructions slid Additional Inlorm,tion <br />i <br />i <br />l <br />i <br />7 <br />- - <br />7s <br />GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping i <br />name and are classified. packed, marked and labeled. and are in all respects in proper condition for transport by highway according to applicable <br />international and national government regulations. <br />It I em a large Quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have <br />determined to be economically practicable and that I have selected the practicable method of treatment, storage. or disposal currently available to , <br />me which minimizes the present and future threat to human health and the environment: OR. if I an a amall quantity generator, I have made a good <br />faith effort to minimize my waste generation and select the best waste management method the available to me and that 1 can afford. <br />Typed Nam 1 I <br />ipnat ra Alonrh Day Year <br />°,' e s <br />0 B <br />R <br />ITransporter 1 Acknowledgement of Receipt of Materials 1 <br />A <br />H <br />Printed/ Typed Name S r Monro Day Year <br />P <br />ISS V <br />R.....T <br />18. Transporter alwrter 2 Acknowledgement of Receipt of MHedab <br />T <br />E <br />yped Neme <br />Signature Abnm Day year j <br />19. Dbcrepancy md-tlon Space <br />F <br />A <br />C <br />I <br />L <br />1 <br />20. Facility Owner or Operator C ilic,tion o ecsipt of hazardous materials covered by this manifest except ere n 'n hem 19. <br />VPenta <br />Signature Alorrm Day Year /y <br />DHS 9022 A (1 /8f) - <br />EPA 8700-22 <br />(Rev. 9-88) Preview editions are obsolete. <br />White: TSDF SEt}B�THIS COPY TO DOHS WITHIN 3 <br />To: P. Box 3000, Sacramento, CA 95812 <br />ON THE BACK <br />