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5y $ r t y;. nEiyr <br /> • Cel r an Nf 'd ..,: _ a <br /> ole uLen m�DIWa <br /> plea '^>.(Fgrm:tlealp+' Le`a"one/Hs(I2P .:fYpeliNerJ, T " + � 07777�`11+CCkYlMomia ; <br /> A DOUS <br /> TE iAANIFEST 7..Oener tore US EPA W No ;"A - ' ' >S.Menllee( 2-Pa9e+1 onnation l a Made areae' r°3 <br /> -( RM H 9� '.'.Qg �. ° '�° /:01 `�li riot requlrad by Federal law:- <br /> 3. enerstor's Name and Mailing Address A State Manifest Document.Number <br /> .SC9F�G . cL�ZecT.2.0 !� M/' z, 7i8 CGU <br /> 77 � �-S/4 ,,y. B.,State Generators <br /> iD •Fi° �j <br /> 4. Generator's Phdne( � '103 S"a/y - S/a/`iri'Y. '.� i / <br /> n 5. Transporter 1 Company Name e. US EPA ID Number _" / C.State Transporters ID - <br /> IKII <br /> ifm D. Trenaparter'n Phone <br /> m <br /> 7. Transporter 2 Company Name e. - US EPA 1D Number E. State Tranaporiels 10 <br /> 8 F. Transporter's Phone <br /> 8. Designated Facility Name and Site Address 7 US EPA ID Number G.;Stele Fecility'giD <br /> �s'zs M�ry'�Q (Iy Sp (/ ��t <br /> �-M jE/�(J y H..Facility's Phone <br /> c 'o <br /> 12. Containers 13. Total 14. 1 <br /> '0 11. US DOT Description(Including Proper Shipping Nam.Hazard Clan.and ID Number') - Ouantfy Unit Waste No. ... <br /> LL - <br /> No. Type Wt/Vol ^, <br /> -r - State <br /> Z a�.f// ',u'.e1 .� z/ GoGtU�y / .aQ� ,/� r loll /,/ <br /> G - EP /gheVe,&A <br /> E <br /> 3 N State <br /> A COPIED <br /> FPA/Other <br /> G . <br /> Is <br /> a R C. - - <br /> ' FPA/Ogler -''-�,j <br /> w <br /> d. .Sate ' tr <br /> F <br /> Z <br /> to <br /> _ a) AtldrlionelDescri tion for Meierie tiafetl AboYe"a"t,• <br /> e <br /> so <br /> cc <br /> Z <br /> O - - <br /> 15. Special Handling Inehudiona and'Atldltional inlortnetion . , ��. "• s <br /> J <br /> 16 _ ` l <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignhisin ars fully arld accurately described above by proper shipt name - <br /> t end are classified,pecked,marked;end labeled,and are N all aspects in proper condition hx transport by highway according to applicable MemetkWull and <br /> national governnmment regulations. ..- ., <br /> tL :.81 am a Iarge quenfiy generator,1.cerlHy that I have a program N place to reduce the vclume.and toxicity of waste generated to the degree i he"determined <br /> O 'to be economically practicable and that I have selected the practicable method of treatment.storage,or disposal currently available to me yhlptl minim@es the <br /> } ' 'present and future threat to human health and the environment;OR.H I am a.small_quantity generator.I have made A good falth effort to minimize my waste <br /> U generation and select the beat"eta management method that Is available to ms and that I can atford _ <br /> Z Month Day Year . - <br /> WPrinted/Typed Name ignature . <br /> 0 <br /> W <br /> T 17, nnaporter 1 Acknowledgement at Receipt of Materials <br /> _ R - MmM• Day Year <br /> Z <br /> 8 Pdnte p/eE �O Signet % <br /> mPO- 18. Transporter 2 Acknowledgement of Receipt of Materiale- <br /> a T Printed/Typed Name - Signature Month Day Year <br /> O E <br /> Z_ <br /> 19. Discrepancy Indication Space <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 except as noted in Item 19. <br /> Y Printed/Typed N e a Signet _ Mo Day e <br /> 1 <br /> DHS 8022 A(1/88) - Do Not Wly <br /> rite:Below This Line <br /> EPA 8700-22 <br /> (Rev.9.88)Previous editions are obsolete. <br /> Yellow:.TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />