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3tatu of Califor^ia- talth and Welfare Agency Department of Health Services <br /> Form Approved 49MB No. 2050=4 39(Expires 9-30-9 jr Toxic Substances Control Division <br /> Please print or type. (Form designed for use on ai',9e(TP-pitch typewriter). Sacramento,California <br /> UNIFORM HAZARDWS 1. Generator's US EPA ID No. Manifest 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST CAD 91811131_6J2191;1 4 Do 1 ment No'7 of I I is not required by Federal law. <br /> 3. Generator's Name and Mailing Address iQ d(.- . .l -,' ''7 A. State Manifest Document Number <br /> LODI :METAL TECH- `_ �/-.�7-C - 89578394 <br /> 213 S. )SLY ROAD LODI CALIFORNIA 95241 `�I B. State Generator's ID <br /> 4. Generators Phone( 209) 334-2500 g IA IH IQ 13 16 0 1112 2 9 4 <br /> 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID C <br /> B 0 R DIDUSTRIES C I AlDi 11012181217151919 D. Transporter's Phone t 916 372-2342 <br /> N <br /> U) 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID <br /> C9 <br /> p 1 F. Transporter's Phone <br /> 0 <br /> c0 <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> USEcology '31 '310101 11 U1 01010INIVITI <br /> d'c U S HICMIAY 95, 12 MILES SOUTH OF BEATTY H. Facility's Phone <br /> U <br /> O)Q BEATTY, NEVADA 89003 N V T 3 3 0 0 1 0 010101 (702) 553-2203 <br /> ME <br /> 12. Containers 13. Total 14. 1. <br /> 0c'0 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Quantity Unit Waste No. <br />�Q No. Type Wt/Vol <br /> State <br /> Z G EPA/Other <br /> = EQK3 11' 02 <br /> oo--p; N <br /> E b. SWe <br /> O R <br /> cp T D tac }� �{'� EPA/Other <br /> o O <br /> ty State <br /> v R c- <br /> 8 AUG 20 1990 EPA/Other <br /> WI._0 D I M • Slate <br /> Z <br /> w <br /> EPA/Other <br /> U <br /> rn J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> CL <br /> U) <br /> Cr_j yLt/ N 1 <br /> Q <br /> Z <br /> O <br /> I- 15. Special Handling Instructions and Additional Information <br /> Z <br /> W <br /> S <br /> F- <br /> J <br /> J <br /> U <br /> 16. <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and <br /> d national government regulations. <br /> 11 If I em a large quantity generator.I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined <br /> 0 to be ecenomicaily practicable and thatI hE=ve selected the Practicable method of treatment. storage,or disposal currently available to me which minimizes the <br /> } present and future threat to human health and the environment;OR,if I am a small quantity generator.I have made a good faith effort to minimize my waste <br /> U generation and select the best waste management method that is available to me and that I can afford. <br /> Zt Month Day Year <br /> Lu Printed/T ped Name f / Signet y� <br /> w / /l/ , r 0 <br /> Lu T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> R Month Day Year <br /> A Printed/Typed Name ( �:=gnatue � <br /> LL S ,C, K C l c.I v y r,V t 7 ` r. �, 0 <br /> O p <br /> UJ O 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> Q R Printed/Typed Name Signature Month Day Year <br /> UE 1910 <br /> Z_ <br /> 19. Discrepancy Indication Space <br /> j� <br /> F �(�ltt a iJUN�.� tn(,(fhfQ��. �ct� .� v0 F'�V` IP.0J. -ZQg#IP <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest.frxcept,,�s rioted-ih Item 19. /f <br /> T Signature _ Month Day Year <br /> y Printed/Typed Name f jj <br /> Q! J H9 % 14L 101 A <br /> DHS 8022 A(1/88) Do Not Write Below Thisitlinr <br /> EPA 8700-22 <br /> (Rev.9-88)Previous editions are obsolete. <br /> Yellow: TSDF SENDS "SIS CO^Y TO 'GENERATOR `wliY.!N <br />