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FteOf irrafection Agency <br /> "Approved OMS No.2030-0039 1 Expires 9-30-991 See Instructions an back ofp6. Department of Toxic Substances Control <br /> se print or type- Form designed for use.elite 112-pikh,IYPo <br /> —i e Sacramento,California <br /> 1. UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page I Information in the shaded arc-as <br /> WASTE MANIFEST <br /> CA1- o is not required by Federal law. <br /> 4 Generator's Nome and Mailing Address <br /> ii7I <br /> N <br /> PacMc Bell <br /> P.0-Box SM:Room 3E000 Sm Ranh CA 4�& <br /> ,it. Generator's Phone <br /> an-TT"- <br /> 5- Transporter I Company Na-me <br /> 6. US EPA ID Number <br /> --C~COnW kXkXWM in 1117 1-t <br /> EIAIiJ421210 3 <br /> 7. Transporter 2 Company Name III,-Us 9A I5-NJmbW <br /> 9. Designated Facility Name and Site Address 10. US EPA 10 Number <br /> 2061 Bay Road <br /> East PaW Me GA 94303 F� tj lerj ej <br /> I I. US DOT Description(including Proper Shipping Name,Hazard Class,and 11)Number) I miners 13. Total ]A. Uni <br /> No. ';ryqoi� Quantity WI/Vol <br /> G W--note 6011H <br /> E <br /> N <br /> 00 E i4i,AV t -1 0J r S i V /9 <br /> A I/ 7- <br /> R ir, <br /> T <br /> 0 <br /> R <br /> & <br /> Z <br /> LU <br /> 5, <br /> V <br /> -J <br /> F <br /> 0 15. Special Handling Instructions and Additional Information <br /> Wear pfoper protenccflve equilpraient w1h-lie hariffling- VVeig As or volumvies are approxin-mate- 24 <br /> Hour emeraencv telephone number 1-91 6-977u-7777 (Pacific Bell) ERG# 128 <br /> 11 cons, <br /> 1Z"dE'NrR'A18R'S CERTIFICAn0iT'&,.6y—=-,=r. s riment are fully and accurately described above by proper shipping name and are classified,packed, <br /> contents <br /> marked,and labeled,and are in all respects in proper condition for transport highway according to applicable international and notiono government regulations, <br /> a large quantilogan:rolor,I certify that I h pr ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> sr s is = have <br /> 0 <br /> practicable and that I led the rraclic.61.method treatment,siorage,or disposal currently oveilar-He to me hiah 1011", <br /> It resent and Future threat to human health <br /> and the environment;OR,if I am a small quantity generator,I licive made a good Faith effort7imine my w generation and s4lec e best waste mormerif me"that is <br /> availoble to me and that I can afford, 111 or" <br /> Printed/Typed NaSignature Month Day Y. <br /> tLb <br /> 17. Trans iter I Acknowledgment of Receipt ohZe6c;ls <br /> It <br /> A Pnnladftyped me signature L Month pay Year <br /> Is, 1=1—tAa-,L-- 1"Z-1 /ky or I <br /> a I& Transporter 2 Acknowledgement of Receipt OF Materials <br /> , -p�Wed/Typecl Name Signature month Day Year <br /> T <br /> F <br /> 19 Discrepancy Indication Space J <br /> F <br /> A <br /> C <br /> L <br /> 1 20. Fo ili!y Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> 1 Printed/Typed".rie Signature Month Day Year <br /> y <br /> DO NOT WRITE RELOW THIS UNE. <br /> 1DTSCSMA(1/99) White- TSDF SENDS TH45 COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 8700-22 To7 P-0- Box 3000, Sacramento, CA 95812 <br />