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tate of California—Environmental Protection Agency <br /> arm Approved OM8 No.2j50-00341Expires 9-70-99) See Instructions on back of b. Department of Toxic Substances Contrc <br /> ease print or type- Form designed for use on Are f12-pitch]fy <br /> Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. :2-:Page 1 Information in the shaded areas <br /> WASTE MANIFEST LTi t q D I Q � is not required by Federal law- <br /> i 3. Generator's Name and Mailing Address CJ Adlpfeli} FiOst light Niiier <br /> Pacific Voll <br /> P_O.Box 5M-Room 3EOOO San Raawn r_.d cWRAIA <br /> B. slbfery�ter�rsrii6 <br /> 77 <br /> A- Generators Phone 1 b7b )97[-T1 It <br /> N 5. Transporter 1 Company Name 6, US EPA ID Number SkapeTr slC1 flet' <br /> ECO"cardiol IIEKILHOW IAI 210131011 7 3 <br /> 7- Transporter 2 Company Name 8. US EPA ID Number E. 5iv?4lrutsparter's iM" <br /> 9. Designated Facilityb orae and Site Address 10. US EPA ID Number <br /> i fir na— <br /> nc 2M BWROW y ,..Mid Palo Mo r <br /> A. GA 9+ 3035 216 <br /> . 4, { <br /> 12. Containers - -.*13. Total 14 Unit } <br /> 11- US DOT Descrioort{including Proper Shipping Name,Hazard Class,and ID Number) 2' t <br /> No_ Type quantity, WI/Val <br /> TT�C r� <br /> A <br /> 16,5 31 <br /> e ► ? as l <br /> "a <br /> ,T <br /> o <br /> R <br /> d <br /> w _ <br /> U r. <br /> '� '"k '�tiri # }��i �y r `a � '?'• :_�yfiy�.�,'hya,� �l-TMY f.�r <br /> 15. Special Handling Instructions and Additional Information <br /> ie [ ndling. � eight or are a:3roietc. Aresat �iv ei NiiaEsav£ e�ul eeteiiiiirIxQ <br /> Hour emer4encv telephone number 1-$16-977-7777 (Pacific Ball ERG# 128 <br /> Zvi `��.5Z73 .ire aiie auiiiea5: 3 0pr�acl) 4nP <br /> r <br /> 16. GENERATOR'S CERTIFICATION: I hereby dectore that the contents"I <br /> this consignment fully and accurately described above by proper shipping home and are classified,packed, <br /> Q marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable infernotiona)and national government regulations. <br /> If!am a large quantity generator,I certify that I have a pr ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> practicable and OKA I have selected the pprocticoble 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,1_have made a good faith effort to minimize my waste generation and select the best waste monagemenf method that is <br /> available to me and that t can afford. t' <br /> Pn /Typed NQ - Si Iure Month Day Y or <br /> L� Ib 111 r <br /> LLD U1 17- Trans iter 1 Actino enc of Recri t of Materials <br /> A Nome Printed/T N <br /> I ` Sign re Month Day Y <br /> 5 Ic J <br /> t <br /> 18. transporter 2 Acknowled emenl of Receipt of Materials <br /> T Printed/Typed Name Sign re V Month Do Year <br /> LU f y <br /> I <br /> 19. Discrepancylndicofion Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> I 20. Facili Owner or O for Certification of receipt of hazardous materials covered b this manifest exc f as noted m Item 19- <br /> T Printed/Type me Signature 9nib Day Year <br /> DO NOT WRITE BELOW THIS UNE. <br /> 'C <br /> 8022A 11/99) White TWF SENf)S THIS COPY TO DT5C WITHIN 30 MAYS <br /> A 6700-22 To P 0 Box 3000• Sacramento, CA 95812 <br />