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51ofeof alifornia—Environmental Protection Agency <br /> s Form APP-roved OMB No.2050-0039(Expires 9.30,99) See Instructions on back of a e b. <br /> Please print or type. Form designed for use on elife(I 2-pitch writer, Department of Toxic Substances Con <br /> Sacramento,California <br /> UNIFORM HAZARDOUS enerator's US No. Manifest Document 2. Page 1 Information in the shaded areas <br /> WASTE`.MANIFEST 1 f isnot required by Federal law. <br /> of <br /> 3. Ganerotors N7 Maihn9 Add S <br /> y r •.2 : . f s ;. � -- A Pole anrfesl Dacv, Numlxr jf +/mow �Jj l/''�, <br /> j" ✓./ '.rte, •� r' l syl" {_` �r?�yy {r r rYl V 8;,jj V 16.00. <br /> B. State Generators ID i s <br /> ,{ y x <br /> A. Generator's Phone <br /> cV 5. Transporter 1 Company Name 6. US EPA ID Number ' <br /> r� C. Stale Transporters ID a <br /> T t,t(lr=' 1-,-:t,. {ETI_ t„ h11) 3'... 1 -7 7. 55 <br /> D. jconsporters Phan/ <br /> W :' p 4a.c.klJ � i•:I�•d. r <br /> 7. Transporter 2 Company Nome 8. US EPA ID Number E. State Transporters ID ;e rd s•-i a ; <br /> J <br /> Q F-Transporferas Phone <br /> 9. Designated Facili!y Name and . ddb ss <br /> 10. US EPA 1D Number G Stale Bili 's D 4 <br /> C\j2 1700 '_0TH ! <br /> H Facility <br /> C. <br /> �_ -a }^ J-si It�C�F�. a.--i-'�. 'Ji-!i•)..-_ t'`sI o 1 -�•d �. t °.. � . . Z- <br /> : s n. <br /> U1 I. US DOT Description lincfuding Proper Shipping Name,Hozord Class,and ID Number) 12. Containers 43. Total 14. Unit <br /> ODNo. Type Quantity Ws/Vol f Waste Number <br /> f'ti�' !—I s . A Hf�.= T !_ ! D.11 r Sts 2 <br /> E i/1 EPA/01her, <br /> - r <br /> 0 N b. <br /> 00 Seale r r <br /> 00 E <br /> N EPA/Other <br /> R <br /> CN A <br /> 6 T C. <br /> 0 O Stale <br /> R EPA/Oiher <br /> x <br /> LU d. <br /> zState <br /> EPA/Other <br /> w <br /> z J. Addttianal Descriptions For Materials Lisled Above <br /> F K Hiondlang Codes for Wastes lasted Above f <br /> ,3AN4 ,113C3TQM WASTE,.; =t ` z�ti- >rr a b <br /> ;�IN <br /> y�TIE <br /> -' r <br /> cl <br /> s <br /> 0 15. Special Handling Instructions and Additional Information <br /> Q si=T'ir:E)F°P-'ATE Fw[;'f�'(-EI :TT'JE C:R_0T}�:tt`!Ia <br /> Z "re~t E.T F') Elki r.,, f:OINTA ?LU <br /> H <br /> Q16, GENERATOR"S CERTIFICATION: I hereby declare that the contents of this consignment ore fully and accurately described above by proper shipping name and ore classified,packed, <br /> V marked,and labeled,and ore in all respects in proper condition for transport by highwoy according to applicable international and national government regulations. <br /> i J <br /> �J If I am r. force auantih/,cene,a!or,!cnr!ifl•:hat I ho+'e a p:oarnm i-place la redu-e!hri Volum'and to iciy of waste y unrated to the degree i have determined to be e[onomieoiiyy <br /> ' procticabie and Thal 1 hove selected the procticoble method J treatment,storage,or disposal currently available to me which minimizes rhe present and future threat to human health <br /> and the environment;OR, if I am a small quantity generator,I have mode a good faith effort to minimize my waste generation and select the best waste management method that is <br /> Ce ovaila61e to me and that I can afford. <br /> 0 _r <br /> }• Printed/TypeclNorne Signature <br /> •"' ,r-,r,? r <br /> V l' month- Do � ar <br /> w T <br /> (� 17. Transporter I Acknowled ement of Recei t of-Mat-W. / <br /> LU 4 Printed/Typed No' J / <br /> Nr <br /> J- Signature % Mgnth-. Day__. Yeaf� <br /> iy F a' l fi 1 <br /> w R 18• Transporter 2 Acknowledgement of Receipt of Materials <br /> 0 F Printed/Typed Name <br /> w E Signature Month Day Year <br /> Lo R <br /> a <br /> V F 19. Discrepancy Indication Space <br /> A <br /> — C <br /> I <br /> L <br /> I rdintecl� <br /> FacilityOwner or Operator Certification of receiet of hazardous materials covered b this manifest except as noted in Item 19. <br /> T Name f Signature! / N)onlh Day <br /> Year <br /> r <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A 14/97) <br /> EPA 8700-22 <br />