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IiApproved OMB No.2050-0039(Expires 9-30-99) U ✓ f J s L/ Jee Instructions on back of page 6. Department of Toxic Substances Cc--- <br /> print or type. Form designed for use on elite(12-pitch)typewrifor. Sacramento,California <br /> UNIFORM HAZARDOUS I• G tor's US EPA ID No. Manifest Document No 2. Page II Information in the shaded areas <br /> - <br /> WASTE MANIFEST A. 1., 0 10 ,� ._I LI � i 9 9 1 5 9 4 $ of 1 is not required by Federal law. <br /> 3. Generator's Name and Moiling Address A. State Manifest Document Number ^ fl 9 2 <br /> f2£3U BUILDING 6 PP.CFERT:'. 9'7 � ':T+� I':�LIe C:LNL� L <br /> 3'1 E.. CHhi{13EL 9't_ <br /> 3r1'C l.i_iF, Let `_a 2 0; B. Slate Generator's ID <br /> 7 <br /> A. Generator's Phone 9 9 6—7 7'S 0 <br /> 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> D <br /> tF q Q 7 D. Transporhr's Phone C-e 0 0 9^,4e—7-4-4 9 <br /> 7. Trans Ver2 Cam an Name <br /> P Y 8. US EPA ID Number E. State Transporters ID Reserved.] <br /> - 1 <br /> f. Transportar's Phone � <br /> 9, 6esignated Facility Name and Site Address 10. US EPA ID Number G. Stat <br /> g4'a ily;�iQ (J <br /> S r� <br /> i3 em � rJ 71�J f <br /> 13-1 3 A:o'£. H. Facility's Phone?1 3 _ -7—7 <br /> l� R. al 4 tl v o 13 4 4 -3 2 JD � <br /> 't 7Z� <br /> J <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br />' No. Type Quantity Wt/Vol I. Waste Number <br /> ;'IL. Tr.�C£° _;c F•r F_as State <br /> EPA/Other` <br />' G G D 1 D F 3 rj r, <br /> N 6. <br /> State <br /> E <br /> R EPA/Other <br /> i A <br /> T c. <br /> Slate <br /> 7 0 <br /> R EPA/Other <br /> d. <br /> State <br /> j EPA/Other <br /> 1, Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> 1 a F}.C�':_£ xCG7103 a. f� b. <br /> s <br /> C. d. <br /> j 15. 5 ecial Hancili Instructions and Additional Information <br /> -%i?_f c :A L Pf'-'1'£CT'I'VE �Lt�rhtT.lG <br /> '2iL'7.G£I;C7 t:C117ACT: (300! 7,3E-^1.949" <br /> E:_R '2 . PAGE x 171 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are Fully and accurately described above by proper shipping name and are classified,packed, <br /> marked,and lo6eled,and are in all respects in proper condition For transport by highway according to applicable international and national government regulations. <br /> If I am 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 determined to be economically <br /> practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which,minimizes the present and Future threat to human health <br /> and the environment;OR,if I am a small quantity generator,I have made a good Faith to minimize my waste generation and select the best waste management method that is <br /> available to me and that I can afford /' ' i �� <br /> jXqvNome. Signa e ,1 / / �..,�' Month Day Year <br /> TT 17, Trans orter 1 Acknowledaement of Receipt of Materials <br /> Printed/Typed't'Jame _ Signature Month Day Year <br /> 0 18 Transporter 2 Acknowiedoement of Receiot of Materials _ <br /> T Printed/Typed Name, -- Signature ` �_� Month Day Year <br /> R <br /> 'S <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> L <br /> 1 20, Facility Owner or Operator CertiFtation of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> j Pjinred/Typed Name' Si naturei nrfr D i i Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> 'SC 8022A (1/99) <br /> A 8700-22 " <br />