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.State of California—Environmental Protection Agency <br /> Form ApprdOad OM8 No.2050-0039(Expires 9-3099) `` See Instructions on back lase 6. Department of Toxic Substances Control <br /> PV ssa print or type. Form designed for use on elite`12-pit[Tl4svvribr. r,i Sacramento,California <br /> UNIFORM HAZARDOUS Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST C oF' is not required by Federal low. <br /> 3. Generator's Name and Mailing Address kt ( A. State Manifest Document Numbe21142748 3 T 3 <br /> 0. State Generator's ID <br /> h4. Generator's Phone Z011 ) <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. Stale Tr sa orter's to Reserved.] <br /> sn <br /> m hu{':l ii t� -v i�.'s„F::s acne' ..'';!is /.@I[.: <br /> 114 <br /> 1- <br /> .r.3 L' y <br /> O' - D. Transporter's Phone <br /> O <br /> �: 7. Transporter 2 Company Name S. US EPA ID Number E. Stake Transporror's ID[Reserved.] <br /> F. Transporter's Phone <br /> U + F and Site Address 10. US EPA ID Number G. Sta Fa Ji ID,. <br /> ;: iP?F4BqH-Ti ($�:° fJ ,:'� O, c2 2S ti i�r <br /> Zs t 31>rkf+ t�si <br /> W C r ;t, H. Facilittyy s Phone <br /> Ort. ., , 'F 'L1275 90Gi <br /> —q Q 11 US DOT Description(including Proper Shi n Name,Hazard Class,and ID Number 12. Conjoiners �' 13. Total 14. Unit <br /> J P h 0Shipping I No. Type Ouadtiy Wt/Vol 1. Waste Number <br /> •_$T t,R l'#fris."Ak00U-5 V4 AS 1 t'- 0Q,Li4 VState , <br /> i OILY IJVA 1 <br /> 3 Gr EPA/Other <br /> zv N b. state <br /> 0 <br /> .m. E <br /> R EPA/Other <br /> v A <br /> o T c. State- <br /> m O <br /> R EPA/Other <br /> w <br /> J. <br /> State <br /> H <br /> Z <br /> I" <br /> U EPA/Onhe, <br /> w <br /> J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> 0 OILY VIVATFIR a a,.:i b. <br /> 6 <br /> zs� <br /> h <br /> w <br /> a. d. <br /> a <br /> Qs15. Special Handling Instructions and Additional Information f s 66 <br /> L 3,E kk f�.Y(6rL <br /> Zg,,sl.}.(a <br /> = R tdlc..k, s}L"r -'1v'yy'i l7L ' Y) <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> Umarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <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 economically <br /> d practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> 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 waste management method that is <br /> ac ...liable to me and that I can afford. <br /> O P,rin /Ty Name ( II Signatsye^ -_. / Mont, Day Year <br /> Z .iC.. lr`JT' -L.A•�., / .t. #? . ter , r} <br /> w T 17. Trans trot 1 Acknowled e'menl of Receipt of Materials + <br /> °C Printed/TY dName SignatureLit <br /> , t �... r Month Day Year <br /> R ry y/ j <br /> yt P / • / / tM.e'\. rYLr .F✓ <br /> LL tag <br /> a 18. Transporter 2 Acknovied emenl d Re t of Materials <br /> R Printed/Typed Name Signatere Month Day Year <br /> T <br /> N E <br /> Q R <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19, <br /> T Printed/Typed Name Signature Month Day Year <br /> Yr :. :c, .. r. <br /> DO NOT WRITE BELOW THIS LINE. <br /> `fellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> (Generators who submit hazardous waste for transport out-of-state, <br /> DTSC 8022A(1/991 produce completed copy of this copy and send to DISC within 30 days.] <br /> EPA 8700-22 <br />