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wPruveo UM6 No. 2050-0039 (Expire, 9.30-8e) <br />Plea <br />i <br />i <br />i <br />t <br />u <br />3 <br />L <br />Department of Health S. <br />D 8022 A(1/87) <br />EPA 8700-22 <br />(Rev. 9-86) Previous editions are obsolete. <br />White: ISDr SENDS THIS COPY TO DOHS WITHIN 30 DAYS INSTRUCTIONS ON THE BACK <br />To: P.O. Box 3000, Sacramento, CA 95812 <br />I,_.._--- ----- <br />.tee . ----.----..�...ee w.nrnn u <br />- vpewn a Sacramento, f. <br />UNIFORM HAZARDOUa - t Generalor'e US EPA ID Na. Mank 11 - <br />2 Pape 1 <br />Document No. Information in the shaded are: <br />WASTE MANIFEST �U °f <br />' <br />' is not required by Federal law <br />3 Generator' Na and Mailing Address <br />A. Stale Manlla*1 Document Number <br />' /qlx� <br />/� 7� 1 �a <br />ev 41 [fix <br />5634 <br />4. Generator's Phone,a•� ) ! ` A I M iiu- 64- B. Slate Gen ror'a 10 <br />0 <br />,S7 z 6) <br />[/ <br />5. 7 ansp rler I,Comp y Name 6 ] 6. J <br />a' <br />D <br />US EPA 10 Number C. Slat�Transponsr' <br />'ray <br />2 D. Tran <br />.Transporter 2 Company Name 8. <br />o <br />o <br />US EPA ID Number�. <br />111 / t / / 1 E. StelD <br />`A <br />�. bt <br />f ') r Transporter'* Pho _ <br />9. Designated Facibly Name and Site Address 10. <br />US PA ID Number G. Slate Facility'* ID <br />(K �I�J <br />/�fLl.^71.•�,fl/ ," <br />2 <br />Q <br />1I1:)G /�"'I/IGCIx. <br />T(: �1 ' /-/ 1 I H. ilily's P <br />C- 2 / 37--7,6& <br />0 <br />11, US DOT Deacrip0on (Including Proper Shipping 12. Container 13. olal 14. I <br />p pping Name, Hazard Class, and ID Number) <br />z G <br />Quantity Unit Waste No. <br />No. Type Wt/ Vo <br />a wa,+e 1 4;�,b��l b 1 L.; Slat. <br />- E <br />(/((� <br />� N <br />E <br />EP O er <br />b. <br />No q <br />A <br />State <br />V <br />u 0 <br />a <br />c. <br />EPA/Other <br />R <br />n <br />State <br />c <br />EPA/Other <br />u <br />d. <br />u <br />State <br />J <br />U <br />EPA/Other <br />J. Additional Descriptions for Materials LI1ds0 Above <br />K. Handling Cotle* la Waste& Listed Above <br />j <br />a. b. <br />/ <br />c. i <br />oil <br />`f <br />15. Special Handling Instructions and Additional Information <br />FEB 1 1989 <br />GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described rabove b ' oy <br />name and are classified. packed, marked, and labeled, and are in all respects nu <br />oto <br />in proper condition for transport by highway according <br />international and national government regulations. applicable <br />II fish 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 <br />determined to be economically practicable and that I have selected the practicable method treatment, <br />of storage. or disposal currently available 1 , <br />me which minimizes the present and future threat to human health and the environment: OR, if I am a small quantity generator. I have made a good <br />faith effort to minimize my waste generation and select the best waste management <br />method that is available to me and that I can afford. <br />Prince T ed Name Signature <br />MonIA Day Yu.. <br />T <br />R <br />17. Transporter I Acknowledgemen of Receipt of Materials <br />A <br />N <br />Printed/T ed Name Signature <br />S <br />-Month Day Yu.. <br />P <br />O <br />18. Transporter 2 Acknowledgement Receipt of Materials <br />R <br />T <br />Printedi' Yped Name Signature <br />E <br />Month Day Yu.. <br />19. Discrepancy indication Space <br />F <br />A <br />C <br />I <br />L <br />I <br />T <br />20. Facility Owner or Operator Certification of i acalpt of hazardous materiels covered by this manifest except as noted In Item to. <br />V <br />Primed/Typad Name Signature Month Day yo., <br />HS <br />L � <br />D 8022 A(1/87) <br />EPA 8700-22 <br />(Rev. 9-86) Previous editions are obsolete. <br />White: ISDr SENDS THIS COPY TO DOHS WITHIN 30 DAYS INSTRUCTIONS ON THE BACK <br />To: P.O. Box 3000, Sacramento, CA 95812 <br />I,_.._--- ----- <br />