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State of California—Environmental Protection Agency ' <br /> Form Approved OMB Na-2056-Od39{Expires 9.30-99) See Instructions on back of e 6. Department of Toxic Substances Control <br /> Please print or type. 'Form designed dor use on elite(12-pifch)Oiler. Sacramento,California <br /> UNIFORM HAZARDOUS 11.. Generator's US EPA ID No. Mari Document No. 2 Page 1dFlat'" <br /> in the shaded areas <br /> WASTE MANIFEST L'Jai/r} ! }T /� �; of / required by Federal law. <br /> I / � <br /> 3 Generator's Name and Moiling Address A. State ManifesITXcumrent Number p� <br /> 71 <br /> f <br /> �'•(/ ,r , 'Cry rY € ,,II r�1! 8, State Generator's ID <br /> IX) 4. Generator's Phone <br /> cv 5. Transporter 1 Company Name 6. US EFA ID Number C. State Transporter's ID]Reserved.] <br /> eel � <br /> „(- t IJ 1, f ,( l V/Al 11)h. D. Transporter's Phare <br /> O FI T� (// <br /> op 7, Transporter 2 Company Name 8. US EPA ID Numher E. State Transporfer's ID[Reserved.] <br /> F. Transporter's Phone <br /> Q <br /> 9. Designated Facility Name and Address 10. US EPA ID Number G. Slate Facility's ID <br /> JAebm �r <br /> H. Focili s Phone <br /> 0 9Z T4 IMP(Iii <br /> ,.� 12. Containers 13. Total 14. Unit <br /> 11, US DOT Description(including Proper Shipping Name,Hazard Class,and.ID Number( <br /> lJyryt��r/y.,�.- ,p ,/ y77 / �^^ // �y ' / No. Tye Quantity Wt/Vol I. Waste/Nurmber <br /> Za ohi/"--'!"- Afi• 141, r` 1 4-ii 1 1&v 1 f V .rs r�� stare•�f"«J <br /> E �� �' ��f JJ {r!/tea CfjC/ T { i EP Ir{ [- /, <br /> QN b. State <br /> ado E <br /> V R EPA/Other <br /> CN <br /> A C. State <br /> o T <br /> O <br /> R EPA/Other <br /> rY <br /> LU d. State <br /> Z <br /> LE <br /> EPA/Other <br /> to J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> Q ,/ <br /> h4�iG �s-7G'�rG' a. b. <br /> u.t <br /> c. <br /> © 15. Special Handling Instructions and Additional Information /j�/ f 1'. ,,-77 <br /> z G1/ jE'. �f ' l`"�t?fF, 3' " k�l "li/ /t1f1a1/A Cil , <br /> LU <br /> YIX 144-7 8 <br /> -Z� 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above 6y proper shipPing name orifi ore classified,packed, <br /> 'Q marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and notional government regulations. <br /> V <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 Yhave determined to be ecar icatly <br /> V) practicable and that 1 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 sn it 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 available to me and that I can afford. <br /> O <br /> } Printed/Typed Name {—r-j,rl f C ,- ',d' Signature / Month Day Year <br /> ,� �? �,� c ►*r�-L; <br /> ua T 17. Frans orterI Acknowledgement of Receipt of Materials Or /f <br /> 0 <br /> APrinted/Typed Stgnaturll,'' i` +, Month Day Year <br /> LU s « r awl C: ? <br /> i a 18. Tr ns orter 2 Acknowled ement of Receipt of Materials I <br /> O R Printed/Typed Name Signature Month Day Year <br /> T <br /> Lu E <br /> `n R <br /> Q <br /> V 19, Discrepancy Indication Space <br /> Z E <br /> A <br /> C <br /> l <br /> L <br /> f 20. FacilityOwner or Operator Certification of receipt of hazardous materials covered Inthis manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y ` <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8422A 11/49J GENERATOR RETAIN', <br /> EPA 8700-22 <br /> k^ <br />