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I <br /> State of Coii(ornia—Env ronmental Pr ecticn Agency <br /> Form Approved OMB No 2050-00791fExpkres 9.30-991 See Instructions on back Of page 6. Department of Toxk Substances Carl <br /> Please p,m or type Form designed for use on elite(I2-pikh)typewriter, Sacramento,Cahfornua <br /> 1. Generator's US EPA ID No. Manifest Document No 2 Pogo I Informakian in the shaded areas <br /> UNIFORM HAZARDOUS � —� is nor required by Federal law <br /> WASTE MANIFEST ] / �j a� <br /> 3 Generator s Name and Mailing Address r� A,°f U�" r r� d 't' /�Gx�r� � 8 ',�a {/��■J{ <br /> _ � � rte•,. � t t l:t - <br /> u's 4 Generoter's Phone! d.� �'1�.'r!'L�i 7�� Lam] r4r L�C..�i.�r•,•� [. V`Y" <br /> h <br /> ry 5 Transporter I Company Name 6. US EPA to Number ' <br /> �tQJ tt'1�t.,�a'L 2 a. "r t.,•I, , _ .L .. r .., .. w+. r'� ri s !l /', !•. h �t w rs -. ` L_„g Y ; �S-f <br /> 0 <br /> co Transporter 2 Company Name 8. US EPA ID Number <br /> b r ft <br /> < <br /> V 9 Designated ltFqu4ivy Name and Sde Address 10. US EPA ID Number <br /> r <br /> k\lu <br /> Z '. i t I t.r+ r ,, `F. <br /> r� " <br /> V <br /> I 12. Cawainers 13 Total 14, Unit r Y <br /> I US DOT Descnpnon(Including Proper shipping Name,Hazard Class,and ID Number) <br /> tr r lJ No. <br /> Type Quantity <br /> VJt(Voi f °rids c N it«er <br /> Za Sta <br /> 1 Y s T T I i EPr/Qtner <br /> 7 G r J 4 } <br /> oar N <br /> 1 W E 4 <br /> c R c <br /> �f� <br /> ami 0 l tor' <br /> H <br /> y <br /> Z I 1. AddkitonPJ faQ�t3fihf W n s s'Lv` <br /> cy <br /> ^ 1 <br /> <: �:.n,1' - x` .i #i;. 5...._ 1+:`.�'�. ttl'r+'w".� �kr.:ak tirz �q•. <br /> O5 Special Mandlm Instructions and Add+'kionol Information <br /> 2l g sr <br /> 1 Z i ,,!._C��i'I' ", 1, t I �'?C i Yw'�'• � L�C i `a is ,�-.�-r' <br /> f'hi�3f�f7 <br /> r- <br /> ' <br /> 36 GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consiVrnenl are fully and accurately described above by proper shipping name and are clossdied,pocked. <br /> Q marked,and labeled,and are to all respells in proper condition for transport by highway according to applicable international and national government regulations, <br /> L) <br /> Ii I am a large quoniity 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 to be economicolly <br /> n-' procncoble and that I have selected the procticable method of treatment,storage,or disposai currently available to me which minimizes the present and luwre threat to human health <br /> and the environment;OR,if I ❑ small quantity generator,I have mode a good faith effort to minimize my waste generation and select the best waste management method khat is <br /> aid that ta, fg� (� �� <br /> Q eI <br /> y Pr d Name t I Signature Mon <br /> rsted/TypeSh r vy��, �ePr <br /> ��--� <br /> u' T i 7 Tr )porker I Acknow6ed em nt of Recei`I of Materials �� <br /> �I s 'vrinle /Typed ame Signoturo r /t <br /> P <br /> q 18 Trans orkers2 Ac4nowled ement of Receipt of Materials <br /> Q A1 Printed/'Typed Nome Signature Month Day Year <br /> I <br /> Nl E <br /> R <br /> V I 19 Discrepancy Indication Space <br /> Z <br /> F <br /> A <br /> C <br /> I i <br /> !I I 20 Fool:r Owner or O stator Cerfificokion aE recei k of hazardous materials covered b this manifest exce t as noted in Item 19. <br /> ' Si nature Month Day Yea <br /> T { <br /> Pr.rated/Typed Nome 9 <br /> Y f <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A 11/99) Yellow GENERATOR RETAINS <br /> EPA 8700-22 <br />