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)late or'_ohrornoo—cnvlronrnen,al rlulvuw nya,+•.r <br /> See Instructions on NICK Ot page O. Department of toxic auaslo <br /> Fom Approved OMB No.2050-0039(Expires 9-30.991 rnia <br /> Plt:he print a, type. lona designed for use on aliler(12-pitchI typewrilar- Sacramento,California <br /> Generator's US EPA ID No. Manifest DGcu 2. Page ! lnformat an in the shaded areas <br /> UNIFORM HAZARDOUS f 1 .3 is not required by Federal law. <br /> WASTE MANIFEST2{ E C e f of <br /> 3. Gene ame and Moiling A ress A. State lAanifesr Document Number <br /> ..] L� �r r , r B. 5tgt+r Cienerotar;tp <br /> hA. Generator's Phone os' ;i f./' �} <br /> ~ & US EPA ID Number C, State Transportsr`s ID served J _ {`,�;L,!„ <br /> tv 5. Transporter I Company Name <br /> D,'Trgnspprror's Pheslle ` � <br /> f `t` 'IF 7. Transporter 2 Company Name 8. US EPA ID Number , State Trgnsporrer's 1p Resen l - <br /> 4;7 F.Tran;porlerrs Pham <br /> U 9. Des gnated Facility Name and Site Address 10. US EPA ID Number G. *tote FacifitYs ID <br /> 71,_r Z 'I-iI: H: F4cifity'sPhane <br /> r t :�{ W.., { f � !� � <br /> O <br /> � 12. Containers 13. Total 14. Unit • <br /> Q 11. US DOT Description lincfuding Proper Shipping Name,Hazard Class,and 1D Number) Na, Type Quantity WI/Vol 1: Waste Number <br /> �` l 'U Slag. <br /> t © N b. �f A! State - <br /> { oma E <br /> v R <br /> A state <br /> c. <br /> Q T ERA/QtiMr <br /> R <br /> ce <br /> Smt+ <br /> w d. <br /> s l- <br /> F U <br /> r Lu <br /> en J. Additional Descriptions far Materials Lsted Above p - K. Handling Codes Ear Wast"u+f+d Above, <br /> .jl '•r 'd tr,:slit-f �l �Fy ,If ,:Nhi <br /> Lu <br /> c' 7. d <br /> O 15. Special Handling Instructions and Additional Information <br /> ;j', . ;...it',t.W.;, •:>•atid�.rV7 Ssr:Vyis�:IlttSss <br /> cu <br /> F � <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and occurataly described above by proper shipping name and aro classified,pocked, <br /> Q marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations" <br /> U <br /> j If I am a largo quantity generator,I certify that I have a progrom in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> ii practicable and that t have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threal 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 /> cc available to me and that I can afford. <br /> 0 / J nth Da Ya <br /> Ma <br /> y P¢ynted/Ty�pled N/prpe } 5igpture 1� <br /> xi. 1 <br /> Z <br /> w T 17- Transporter 1 Acknowled emeni of Receipt of Materials <br /> a <br /> Print ped Nama A Signature"-' `d•.y Month Day, Yee <br /> f <br /> LLjwS � <br /> P P <br /> w a 1 Trans orter 2 AcWowlea ement of Recei I of MaterialsMonth Day Yw <br /> O T Printed/Typed Name 5lgnature <br /> —7 <br /> su E <br /> ua R <br /> W19. Discrepancy Indication Space <br /> Z' F <br /> A <br /> C <br /> L <br /> f 20. Facik Owner or Operator Certification of receipt of hazardous materials caverad b this'manifest exce t as noted' tram 1 <br /> Month Day Yec <br /> T Printed/Typed Name SigttaPow� <br /> 11 ` 1 8a <br /> Y t�-o t,3 T <br /> DO NOT WRITE BEL9W THIS LINE. <br /> DTSC 8022A 0/991 Green: TRANSPORTER RETAINS <br /> EPA 6700-22 <br />