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k <br />C <br />a <br />c <br />dab of California -Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9-30-94) <br />Please prim or Nu. Foi1n deuco,,, a,..,.. .... _� <br />See Instructions on back or •ace 6. <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (7/92) <br />EPA 8700-22 Yellow: GENERATOR RETAINS <br />UNIFORM HAZARDOUS '' "enerakir', US EPA ID No. Manifest Document <br />_.... ,.... - v-, .,voaames �onac <br />Sacramento, CalRorrva <br />No. <br />WASTE MANIFEST <br />2. Page 1 Information in the shaded areas <br />is <br />1 <br />not required by Federal law. <br /><; <br />3. Generator's Nanta and Mailing Address <br />of <br />p <br />A , v .(K <br />an;fost DofdXsgya NlYMhalt, .. .. <br />Y� O F/lceN�U�/T �7. STVCK7011 <br />-- <br />N <br />_ / CafIC <br />4. Gerrorater's Phone ( ' <br />8. St to Ge rotor's ID <br />O <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />to ironsponer's Ib <br />(/ <br />Osportefs Phone -- _.... ..— _� <br />7. Transporter 2 Comparry Nome 8. US EPA ID um or <br />,Transporter`s ID <br />J <br />spotter`s Phono <br />- <br />Z <br />9. Designated Facility Name and Site Address 10. US EPA ID Number—'"-" <br />F.6firyS ID -- <br />`- <br />/S/S 5• k/v z /w. <br />I i f I i LI I � i l <br />r <br />11. US DOT Description (including Proper Shipping Nome, Hazard Class, and ID Number) 12' Comanineez <br />3.T?! <br />14. <br />T <br />E <br />! No. <br />Quits <br />V✓t/Vol cute Nvmber <br />G <br />he, <br />i <br />N <br />b. <br />E <br />S <br />It <br />/Other <br />T <br />c. <br />_. <br />—� <br />O <br />R <br />21994 <br />Other 1 <br />d. <br />ENVIR )NMENTAVLIHEE.SALTH x/alae <br />AlTmER— <br />fing Codes for Wastes Listed Above <br />d. <br />-- --- --- - --- <br />15. Spatial HgndBnq M�sh,{udions and Additional Information <br />� <br />. <br />16. ERATOR CERTIFIGTION: reby dec re al a contenh of the consignment are fully and accarably described above by proper shipping name and are classified, <br />packed, marked, and labeled, add are in all respects in proper condition for transport by highway according to applicable federal, state and international laws. <br />If I am 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 determined to be <br />economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future <br />threat to human health and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br />waste mono ement method that is available to me and that I can afford. t r. <br />Printed/Typed Nome <br />Signai7 �� <br />,.M - bar ear <br />i <br />f <br />T <br />77. Trainspa,iter 1 Acknowledgement of Receipt of Mat `rials _ <br />r D - - <br />e <br />Printed/Typed Name n ey <br />y Sys' � <br />Month Day Year <br />o <br />I8. Tram iter 1 Acknowbd ement 5f Receipt of Materials <� - <br />i <br />Printed/Typed Nome <br />Si -� <br />nature <br />9 G% <br />Month Day Year <br />E <br />e <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />1 <br />20. Facil' Owner or Operator Certification of receipt of hazardous materials <br />covered b this manifest savept as noted in hem 19. <br />T <br />Y <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (7/92) <br />EPA 8700-22 Yellow: GENERATOR RETAINS <br />