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State of California—Health and Welfare Agency "Depenmenlof Health Services <br /> Farm Approved OMB No.2050-OD39(Expires 9-30-9' 0.q&CV Toxic Substances Control Division <br /> Please print or type. (Form designed for use on alit rifch typewriter). Sacramento,California <br /> UNIFORM,JiAZARDOUS 1. Generator's US EPA ID No. Manifest 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST Document No. <br /> 1 ^ of is not required by Federal law. <br /> 3. Generator's Name and Mailing Address 1 A. Stale Manife Document Number <br /> ,5ASu�(,jA (1C)(�y� 1�s)0E—>1- u� lafo 8110192 <br /> Q'1�..[+� ./)11 ''•q )!11 rC� rU.i f/:C O i : GA: B. State Generator's ID <br /> oo a. Generator's Phane( 1ICt t„(/'.S}C'-' 1/t8Z A) /� • i''�' <br /> ap S. Tran"wer 1 Company Name e. - US EPA ID Number C. Stale Trans sea ID <br /> y /1 - / D. Transporter's Phone - <br /> N <br /> m 7. Transporter 2 Company Name S. US EPA ID Number E. Stele Tranaportar'e ID' <br /> 8 F. Transporter'.Phone <br /> m <br /> 9. Dee�naled Facility Neme entl Site Address 10. US EPA 10 Number G. Stela Facility's ID <br /> ,''i �:i„ .r H. Facility's Phone . <br /> r - � <br /> MIX � �� `� � 12. Containers 13. Total 1s. I. <br /> u. 11. US DOT Description(Including Proper Shipping Name.Hazard Class,and ID Number) Guantay Unit Waste No. <br /> No. Type Wt/Vol <br /> _ r _ State <br /> /l'"'1 U e. I L <br /> MrZ GS�a,;. <br /> G00 i —� EPA/qh rr- <br /> 3 N !` it e4 �; i�.a� I I .iJ <br /> E •.�/ 7 r 1 <br /> b. <br /> R LC Ste e <br /> mN t VVI U <br /> T EPA/Olhar <br /> N O <br /> e fl o. Nov r' 1989 State <br /> mEPA/Other <br /> r.s� <br /> W it. ' " State <br /> Z <br /> Z <br /> U EPA/Other <br /> m J.,yArld/"/I/ I Descriptions lot Materials Listed Above <br /> Above K. Handling dee for Innotes Listed Above <br /> N / ' '` `rl Ci �r l .7 r+•CY[f.Ai• �1^'/[r' /•:i a. 1 b. <br /> .I YIJIJ/ +.� G c' it. <br /> Q <br /> 1- 16. Special Handling Instructions and Additional Informalion <br /> 2 <br /> W <br /> J <br /> a <br /> U 6. <br /> GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> af and are classified.packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and <br /> Nnational government regulations. <br /> S If I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste jeneraltid to the degree I have determined <br /> Q to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the <br /> present and future threat to human health and the environment;OR,if I am a small quantity generator,I have made a good faith."ort to minimize my waste <br /> Ugeneration and select the beat waste management method that is available to me and that I Can a"wd. <br /> ZMonth De Year <br /> W Printed/Typed Name Si1(natu e Y <br /> tj11 T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> QR <br /> A Primed/Typed Name / Signature/ Month Day Year <br /> " <br /> h ' f /a a7 e[ d <br /> 0 S [-4e.,.e. <br /> O p <br /> 116 lei <br /> W O 13. Transporter 2 Acknpwletlpament of Receipt of Materials <br /> to <br /> U T Printetl/Typed Name Signature Monfn Day Year <br /> E <br /> 2 <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 11091 .7L <br /> 1 211. Facility Owner or Operator Certification of receipt of hazardous materials covered y margi al exceptarwoMd'Mt <br /> T <br /> y Print T ped Name I Signature _ _ - Month Day Yqr <br /> DNS 8022 A(1/881 Do Not Write Be ow This Line Yellow:TDF SE OPY TO GENERATOR WITHIN 30 DAYS <br /> EPA 8700-22 <br /> (Rev.9-86)Previous editions are obsolete. <br />