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Slate of Colifomia—Environmental Protection Agency <br /> form 1g7roved OMB,No. W <br /> 2050039(Expires 9-30-99) See Instructions on back or a e 6. <br /> pie-;e print w type. Form designed for use on elite 112 pitc�as rite,. 9 D"uhnant of Toxic Substances Contra <br /> `/ Sacramento,California <br /> UNIFORM% HAZARDOUS Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE,MANIFEST 7F !• of nor required 6y Federal low. <br /> 3. Gee tar's Name and Mailing Address A. State Manifest Document Number <br /> �:�. 11IRNKEY r,ut,,,,UN.; <br /> 490 23812533 <br /> 0 INDUSTRIAL PARK ORRFF MM IUCA.CA, 'J V-/ <br /> h B. Stale Generator's ID <br /> ^ 4. Generator's Phone ( 218)"R75 3C Iii -4h1, AHIhI q.>KAhW. <br /> tV 5. Transporter 1 Company Nome 6. US EPA ID Number C. Sbte Iransporser's ID ts(fumved. <br /> as <br /> Rarncs FJf1V11*(hVMHFda1 Services A <br /> Q 4 LF L '1i 56 D. Tronsporterx Phone 916 371-5747 <br /> 7. Transporter 2 Com Nome <br /> P°^Y 8. US EPA ID Number E. Slob Tronspwfei s ID(Resmed.] <br /> M Q F. Transporters Phone <br /> U Desi na Fadlib Nome and S' ddress 70. US EPA ID Number G. St o ID <br /> �-c F'taEn�S �nvtr[/FWWI#ale°3 rr+Faor Q �� <br /> Z 1515 S. Rive'Rd. H. Par....'s Phane <br /> r-io W. Sacranwnto, Ca. '95WI pr�q4 0036 !� 916-371-5747 <br /> 00= <br /> Q 11. US DOT Description(including,Proper Shipping Noma,Hazard Class,and ID Number 12. Containers 13. Total I4. Unit s <br /> (Y3 V P�o^(� ^9 pe ppmg I No. Type Quantity WI/Vol 1. umber <br /> �X C;ombljSt"eR Lpiq�u,, NF.FO..yS., NA1993, PGO S°f' 22, <br /> NE (%/Sed ON) ERG'ia0#i18 / EPA/Other NON�RCftA <br /> 'N / Stab <br /> GO <br /> to E <br /> V R EPA/Other <br /> a A <br /> O T C. <br /> State <br /> m O <br /> R EPA/Other <br /> Zd' State <br /> Z <br /> w <br /> U EPA/Other <br /> w <br /> 1. Additional Descriptions for Materials Listed Abovex' R. Hondlingjodes fpr Wastes Listed Above <br /> O �11Q ' IKSStcAAC �j� a (t`((/ Li <br /> W <br /> J <br /> Z <br /> and r anal lnformmion <br /> rr 15f1E'. T,�"Pity E Yf73�9c4 . <br /> Z v .24 HP.. EMFRC-;ENCY CONTACT'. 918-379-•5747 Job FIr~ <br /> w 400 INDUS"TRIAL.PARK DME, MANTECA, CA., J <br /> Q16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consi9nmentare fully and accurately described above by Propw shipying name and are classified,packed, <br /> U marked,and labeled,and ore in all respec s in proper condition far transport by highway according to applicable international and notional government regulations. <br /> J If ons a large quantiq generaror,I certify that I have a pro <br /> �r in place ro reduce the volume and toxicity of waste generated ro the degree I have determined ro be economical <br /> wpracticable and that 1 have selected the practicable method aF treatment,storage,or disposal currently available ro me which minimizes the present and future threat ro human healMt <br /> and the environment;OR,if 1 am o small quantity generator,I have made a good faith effort famiuil my waste generation and select the best waste mamsgement method that is <br /> avoilabie to me and that I can afford. <br /> > Printego/Typed Name Sigrulure - Month Year <br /> Z MAD K.AiAAL, a 5 I Z 10 1Q <br /> w T 17. Tro" r 1 Acknowled'ement of Receipt of Materials <br /> w A Printed TYPE Name Signal Month Year, <br /> w <br /> Is _ ( ep,!5- os i . f7 Jr e7 <br /> R I8. Trons rfer 2 Acknowled mens of Receipt of Materials <br /> T Printed/Typed Name SignaNre AAontls Day Year <br /> w E <br /> U R <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> _ A <br /> C <br /> C E <br /> I 2 . ili Owner cr O rater Ceel&catlon of recei t of hazard s materials covered this ifest ante I os sorted in Item 19. <br /> T P�inted/T Nome :'� Signature Mon Yeo <br /> d <br /> DO NOT WRITE BE HIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS, <br /> DTSC 8022A(1/99) (Generators who submit hazardous waste For transport out-of-state, <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.( <br />