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St of California—Environmental Protection Agency <br />Form Approved OMS No. 2050-0039 JExpirn 9-30-99 - See Instructions on back Department b. Deparhnt of Toxic Substances Control <br />Plwsa—pnnT- pe. Foran designed forum on egh (1 rpikh)�1Lwrite,. Fc693&71 Sacramento, California <br />C <br />n <br />v <br />a <br />C <br />C <br />7a <br />-R <br />x <br />Vit <br />VL <br />2 <br />3 <br />0 <br />r <br />C <br />Z <br />2 <br />LAWU <br />N <br />Z <br />0 <br />asw <br />Z <br />O <br />Z <br />U <br />6 <br />O <br />V <br />Z <br />K <br />w <br />w <br />LL <br />O <br />a <br />V <br />Kil <br />DO NOT WRITE BELOW THIS LINE. I <br />Yellow: T51DF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />DTSC 8022A (1/99). ,lGime,omrs who submit hazardous waste for transport cP4Fof;sfnte, <br />EPA 8700-22� - ,produce completed copy of this copy and'4nd soDTSCJritltin 30 days.) <br />UNIFORM HAZARDOUS <br />Generabr's US EPA ID No. <br />Manifest Documon No. <br />2. Page 1 <br />Information in deshadd areas <br />LAIP401010101CIILIL17 <br />is not requirdbyFderallow. <br />WASTE MANIFEST <br />-1 I S s/ ti <br />t of 1 <br />3. Generator's Nam& and Mailing Add.... /IAUANC."o D ju j 6AX0AW tC„ T" <br />A. State Manifest Document Number <br />"s c.T"evE sr. <br />1 22315514 <br />M Nslfe csA « 15336 <br />S. State Genelamr's ID <br />4. Generator's Phone ( I <br />S. Transporter 1 Company Name 6. US EPA ID Number <br />C State Tmnsportei s ID Reserved.) - <br />C41- u •e tem n+A p1013191312-174311,1,1145 <br />D. Transporter's Phone <br />� = Sf4 -8'00 <br />7. TranspgrNr 2,CgmPgny Name _ _ R.LS EPA1D Number <br />E. Score Transporter's ID [R�d.J,_, <br />lL.l <br />tv <br />......LLL <br />F. Transporter's Phone -7) \ �l _ (! Y, <br />l� <br />9. Designated Facility Nome ad Site Address 10. US EPA ID Number <br />G. Slate Facility's ID <br />CT As%.) r/AR13o2S SAW TOS: <t c <br />I&AINDIST911/jI41311 Q <br />/osr &AAY ES6A ", <br />H. Faciliys Phone <br />AA) 362,4- . c.4 . 9St ES 3 <br />71. US DOT. Description (including Proper Shipping Nome, Hazard Clms, and ID Number) <br />12. Co^miners <br />13. Total <br />14 Urn <br />No.:. <br />T <br />Quantity <br />Wr/vol <br />I, Waste Number <br />a'AtOk) FCiT'A HAZtiRDaJy X51 G SDL.i EM <br />T R' <br />State'S/2 . <br />oAJ <br />G,EPA/Otte< <br />E <br />o <br />f <br />e o 0 3 <br />N <br />b. Noe RGAA MAZAa.aovg WAWS -;VLXD c8wl?T✓ <br />VMS) <br />State <br />E <br />o fN <br />-7 oo <br />iz <br />AJOUrE <br />REPA <br />-. <br />1 <br />V <br />Tc- <br />�011..Ta r DaIVM NY1�RRbESJf bOLUTS t Y I 1Y, <br />State <br />0 <br />/22 <br />EPAPi hs0 <br />0 0 -� <br />(A <br />6 0 5 <br />�j <br />el. <br />State <br />-- r <br />EPA/Other. <br />J. Additional mcriptionx for Materials Listed Above <br />Y Handling Codes far Wastes Listed Above ' <br />If.a (5) 3 X.GF ' <br />D <br />'�f <br />a ,�q 6 b. (� � l <br />tLb <5>14'�56 <br />rt c lam) f X 55 �A1 (Aoo1) <br />d. <br />10 <br />15. Special Handling Instructions and Additional Informatm �" <br />�49 <br />G L' /-/1 3,07 60 1 <br />se/EA4 DO.oYE0. f'9f. 2,.J NfN NAF,1>K-.�A%. � <br />tif Jos) c U &- i7/$ <br />16. GENERATOR'S CERTIFICATIONS Iharebyd«!aro that the contents of this consignment are fully and xcurti, described above hill shipping nameand are classified;packed,- <br />morked, and labeled, and are in all respects in proper condition (or transport liy highway according ro applicable intemalionaf rad boNonol government regulations. <br />If I can is large-quantigenerates, I certify that I have a prsegmm in place to rducetlhevolume and toxicity -ol-waste generated m the degree I have determined m be xoeomicallyy <br />practicob6 and that I hove selected. the ppracticable method aF Inumment, storage; or disposal <br />currently. available m m• which minimize, the present and future threat to human healtle <br />and the enrirsnaxmtP OR, if 1 am aamall quantity generator, I havemode o god foit ffod to minimize my wastegeneration and mlect the best waste management method that is <br />available m are and hint can afford, <br />:Printed/i f32y4 y lie _ : <br />Signotu <br />a <br />Monthh Day <br />�YEear <br />-T <br />17. TransIocerter I Acknowled ement of Receipt of Materiab <br />It. <br />Printed/Typd Name <br />Example. <br />Month Day Year <br />"s. <br />AID <br />J 1 / $ O' <br />01 <br />�1 E: Trixispartsur.2 Ackwwleda ryes of Receipt of Materials <br />R- <br />PrinNd/Typed Name <br />ign' a <br />Abntl, Day Ywr,$f <br />e, <br />. • <br />- <br />9. bfurepancy Indication. Spore. <br />_ <br />F: <br />A. <br />C: <br />L- <br />(, <br />20. Facili Owmcor Operallor,06rilification of receipt of hazardous maNHalicoverad <br />by this manifest except as noted in Item 19. ' <br />T- <br />PrinxscVTypmd Nome; <br />igwtime <br />Montle Day Yeah <br />Y. <br />L <br />DO NOT WRITE BELOW THIS LINE. I <br />Yellow: T51DF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />DTSC 8022A (1/99). ,lGime,omrs who submit hazardous waste for transport cP4Fof;sfnte, <br />EPA 8700-22� - ,produce completed copy of this copy and'4nd soDTSCJritltin 30 days.) <br />