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Stale of Cohfornia—Environmental Protection Agency Jo,mAppjaved OMB No 2050-0039(Expires 9 30 99) See Instructions on back of page 6 Department of Toxic Substances Contral Please print or type Form designed for use an elite(12 Furth)typewnter Sacramento California I Generator s US EPA ID No Manifest Document No 2 Page I Information in the shaded areas UNIFORM HAZARDOUS is not required by Federal law WASTE MANIFEST G l) 1771 cX y( aft y r 3y/'OV, 98418318 s Name and Mauling Address A Stote Manifest Document Number ^ ry t,t�L I G L C[,p,'n uit1 1y=1 v y�L �! 8 State Generator s ID a V) A Generator s PhoneF-I U lS 75'- C14 t 5 Transporter I Company Name 6 US EPA ID Number C State Transporter s ID " co tr Gorge W. Lowry r Inc { ) !f {� r+ f� D Transporter's Phone y'i�Yrf � ' CD {/ L fJ I I7 Transporter 2 Company Name 8 US EPA ID Number E StateTronsporter s 1D Y i e:r,.+ „ t Q J_��, ✓ �r 1 r I ,f F Transporters Phone V 9 Designated Facility Name and Sate Address .Tt 10 US EPA ID Number G State Facil s 1 Z -, H Facility s Phone � „ w ..to _ ,- y ,7 � � J 12 Conminers 13 Total ]A Unit .' V1 I US DOT Description(including Proper Shipping Name Hazard Class and ID Numbed No Type Quantity t Waste Number ziz. Za VON-RCRA HaZardcu8 WBte Liquid State g j~ (used water) ^. //}} ! �, EPA/CSther , 3 C, 1I V V E o N b 00 coo E EPA/Other + �; Q R Q A State 4Y7i 0 O EPA/Other x, <.i'4' [[ Stale LU d ee ter. ..'t LU EPAJOthei sr ! Addihortal Descn bons for Materials Ctsted Above' K Handling Codes For Wastes Listed Abover}Z ^ �Fryxfr�ti`. p b rr �Y° ? irr ,cfT'l: i1 E .. titr ,- • •+ ,�,� v � Y;-`-"G_r qui _ „syr ? ys $� yx.>tii 0- ��60 s u a tYfr ty d5>;IF n`h+" ''+-. Z44 ERGZ !1 L r.r�, i.A c A d c r,�r^ • r� �� s hyo-ur # , - , � .�' �. ,sem,' +�ig . J � }� r'y, Q Z 15 Special Handling Insrructions and Additional Information o Invoice #!�� �- Use Standard Safety Yrncautions and Standard PPE. Z 24 HOur Facility ( 707 ) 57€3-7300 �V"ri;_If' .' 7467 0'11irs, r l�iF`r '= 24 Hour Generator 1 16 GENERATOR S CERTIFICATION I hereby declare that the contents of this consignment are Fully and accuratelyy described above by proper shipping name and are classified packed Q marked and labeled and are mall respects in proper condition for transport by highway according to apphcohEe International and national government regulations If i am a large quantity generator I certify that I hove a program in place to reduce the volume and toxicity of waste generated to the degree! have determined to be economically prachcoble and that E hove selected the practicable method of treatment storage or disposal currently available to me wh%;h minimizes the present and future threat to human heahh and the environment OR fF I am a tmall quantity generator I have made o good faith effort to minimize my waste generation and select the best waste management method that is ad available to me and that I can afford 'O Printed/Typed Name f r _q�n!r Signature - Month - Day Year T w 1 17 Transporter I Acknowledgement of Receipt of Materials R Month Day Year w p Prmred/Typed Nome t Signature _ r w P r FF 6 18 Trans orter 2 Acknowledgement of Receipt of Materials 0 BPrinted/T Ntpme 7 5ignature (month Day Year I I/e V1 Qiscrepancy Indication Space '66d'-,t nt'f_SCC�t Fit— 114y C Vic ' nI _( S�� L Jr 114,o ;l,3 r l 20 Fccd' Owner.;Operator triificot,on of receipt of hazardous materials covered by this manifest except as noted In Item 19 rMonth Day year I Printed/Typed Name t Signature DO N4Y"WRITE BELOW THIS LINE DISC 8022A EPA 8700-22