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Form Approved OMB No. 2050-0039 (Expires 9-30199) — - <br />Please print or type. Form designed for use oa elite f 12 oitchJ roc <br />See Instructions on bock of px--3 6. Depam,antafToxic Substance:Control <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1 /99) <br />RE I'r.INS <br />EPA 8700-22 ,. �EPIERA tOH <br />Sacrament, Calitomia <br />UNIFORM HAZARDOUS <br />1. a erators US EPA ID No. Manifest Document No. <br />2. Page 7 <br />Infarmalion in the shaded areas <br />WASTE MANIFEST <br />is not required by Federal law. <br />:IF IS i d CY:' t% I I . -, I <br />at <br />3 Gena .tar's Name and Mailing Address <br />_ <br />A St. te Manifest. o_ Number <br />34-10[1GA t,otl;rr�etl�:�� <br />_Went <br />0537 <br />s <br />_ <br />C""�I IivfSF il.! ('.i: 11 s� 4i-iF'iH <br />.1 <br />4. Slate Generator?D <br />0 <br />1 <br />!{� tFf�, <br />b.' ehis tor's Phone I I <br />I <br />5. Transporter 1 Company Name 6. US EPA ID Num6erC. <br />State Transparter's ID IResarced.l <br />.(j, <br />Cn,.- <br />til,il.#fiY L=iSV°`:R.1tltlaR%1'k tilDf'r:iflr. ir':Ii t ": =r t - L( <br />I��I%�awPteS s, Phbtrul <br />7 Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporm,'s ID [Reserved <br />�NVIRON,MEN1 HEALi <br />F. Transp.,fisms Phone MIT/ ERVICES <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. Slane Facility's ID <br />N fti.A14'IE CIA5 iVE' {i,_{ <br />H. Facility's Phone <br />' <br />11. US DOT Description )including Proper Shipping Name, Hazard Class, and ID Num6er) <br />12. Containers <br />13. Total <br />14, Unit <br />No, <br />Type <br />Quantity <br />Wt/Vol <br />I. Waste Number <br />a. <br />Sfae <br />Th .tt.r�E41rNi;�Ttiyt o MS';6"1i,}lrlt t-i1i19 Ayk,.Cv <br />x'r <br />EPA/Other <br />E <br />� <br />s t. r <br />,.. ,1.. <br />b' <br />N <br />State <br />E <br />R <br />EPA/Other <br />A <br />T <br />Stare <br />O <br />R <br />EPA/Other <br />d. <br />Slate <br />EPA/Other <br />J. Addition.] Descriptions for Materials Listed Above <br />K. Handling Codes for Wastes <br />Listed Above <br />6. <br />c. <br />d. <br />15. Special Handling Instructions and Additional Information <br />[: ted. <br />Oil - <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consig ment ore Fully and accurately described above by proper shipping name and are classified, packed, <br />marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable Int rrational and notional regulations. <br />government <br />If I am a large quantity generator, I certify that I have program in place to reduce the volume and toxicity of waste generated to the degree I have determined t be co'c IIy <br />hen. <br />practicable and that) hove selected the practicable method of treatment, storage, disposal l currently available to me which m nmuses the present and future threat to human alth <br />and the environment; OR, if I am a small quantity generator, I have mode o good faith effort to minimize my waste generation and select the best waste management method that is <br />available to me and the, I -on cfford. <br />P t d/Typed Name <br />Sigapt <br />Month Day Year <br />17. Transporter 1 Acknowledgement of Receipt of Materials i( <br />R <br />APrinted/Typed <br />Name <br />Sigh.(ure.., <br />Month Day Year <br />N <br />r <br />✓' <br />r <br />12 11 <br />0 <br />18. Trans orteir 2 Acknowledgement of Receipt of Materials y' <br />R <br />Printed/Typed Name <br />tft re <br />Month Day year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />1 <br />20. facility Owner or Operator Certification of receipt of hazardous materials <br />covered. by this merriest except as noted in Item 19, <br />T <br />Printed/Typed Name <br />Signature <br />Month Day year <br />Y <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1 /99) <br />RE I'r.INS <br />EPA 8700-22 ,. �EPIERA tOH <br />