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\ <br /> dm Approved OMB No.2050--0039(Eaplres 9-30 Toaw SubaSacra mento. amnia <br /> \w <br /> lie as nnl or lips. Form deai nee for use on ere - itch f ,writer. Sacramento,California <br /> UNIFORM HAZARDOUS Generator',US EPA 10-NO Manifest 2 Page i <br /> dd Dc It r Intormation in the shaded areas <br /> WASTE MANIFEST ('✓ll }�do I / IV 151 /IG)'/I / I� � �J f�i l i� t ^sl is not required by Faddist law. <br /> 3 Gen ntor's Ne a ,no half Address A. Stat•Manifest Document Number <br /> y�z/ �icfl a�t/b (,��,N gyp ' \7434884 <br /> JSALr ppAynF_r✓�OC G,� 9.� �,j 7 e/S�lalzrr�frGenerator's 10 ` - <br /> Cenuretor'e Phone(/,G197x+11���� �N�li (. rl' LO yG/OIi f�/I <br /> c I 5. Transposer I Company Name 6. US EPA 10 Number C. Stele Tmnspanei a ID 0114 14 <br /> �(� a <br /> . R , f I I I y D. Tranaponer'o Pho t <br /> 1 <br /> a 7. Transporter 2 Company(Jame S. US EPA ID Number E. Slate Tranapgner's ID <br /> J 1 1 1 1 1 1 1 1F. Tranaporter's Phone <br /> 9 Designated Facility Name and Site Address 10. US EPA 10 Number G. Slate Facility's 10 <br /> t��1351� iP S5EAIti �22o l Ii FAS, <br /> a H. Facilfly a Phone <br /> S-A QJFMJCISCO. CA �l`SID� 1 <br /> = 12. Containers 13. Total lo. 1. <br /> a 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and 10 Number) Ouanlily Unit will No. <br /> No. I Type WI;Vo <br /> J <br /> miry ,asci till Al stela <br /> E FIJI M L9 W v it) U UI �-o 3 E ,Gros, <br /> E b. Slate <br /> R <br /> i A EPA.Other <br /> T <br /> O c Siete <br /> R <br /> I i EPA,Other <br /> u I d. I Slate <br /> I <br /> w EPA,Other <br /> :J <br /> all J. Atltllli`onnal O�Sao pitons ilk'Materials Listed Ab o -�7�7 K. Handling Codas for Wastes Listed Above <br /> ni V/V,yGK� r`-�.Q/NpOR�6e 7/� AUK t,�� � 1J a. b. <br /> d. <br /> ► N TA Mk <br /> r- 15. Special Handling Instructions and Additional Information <br /> w 17 <br /> J <br /> le. <br /> V GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping <br /> name and are classified, packed. marked. and labeled. and are in all respects in proper condition for transport by highway according to applicable <br /> mlemabonal and national government regulations. <br /> N II I am a large quantity generator, I certify that I have a program in place to reduce the volume and tonicity of waste generated to the degree I have <br /> C I determined to be economically praetloable and that I have selected the practicable method of treatment, storage, or disposal currently available to <br /> me Which Inmil file Prurient and future threat to human health and the environment: OR. d I am a small quantity generator, 1 have made a good <br /> faith effort to nnnbnlze my waste generation and select the best waste management method that is available to me and that I can afford. <br /> V <br /> Z Pnn!sfI,Typed Name Signature month Day Year <br /> w , l <br /> w <br /> T 17. Transporter I Acknowledgement of Receipt of Materials <br /> R Printed r Typed Name Bigna Month Day Yaar <br /> < N <br /> LLS <br /> 0 W 0 18, Transporter 2 Acknowledgement of Receipt of Materials <br /> O <br /> W R <br /> Q T Printed,Typed Name Signature Month Day Year <br /> V E � <br /> Z <br /> _ 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 20. Fal Owner or Operator Carhil los of receipt of hazardous mall is covered by this manifest except as noted in Ilam 19. <br /> YFinial Name ! 1 �, Signature Month Day Year <br /> DHS 8022 A(1187) While: TSDF DS THIS COPY TO DOHS WIThIRA&ZAYS INSTHUCTIONS ON THE BACK <br /> EPA 87W--22 T .0. BOA 3000, Socramento, CA 95812 <br /> (Rev. 70G- Previous ediuone are obnoltla. <br />