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SkdNof CaliforrSio Environmental Protection Agency <br />Form 03 <br />Approved OMB No. 2050-09 (Expire; 9-30-94) See Instructions on back of 6. Department of Toxic Substances Control <br />Please print or type. Form designed for use on elite (12pikh) type r. Sacromento;:.California <br />UNIFORM HAZARDOUS 1.. Generator's US EPA ID No. Manifest Document No. 2. Page I Information in the shaded areas <br />is not requr8if by Federal law. <br />WASTE MANIFEST of , <br />J1. <br />3. Generator's Name and Mailing Address <br />.«VLl0pu® <br />of <br />E -4's <br />N. <br />11. US DOT Description (including Proper Shipping Name, Hazard doss, and ID Number} <br />y;4� <br />,uiwIS ON <br />> Q /.�% <br />7& ZMec,,rt/r� <br />C, <br />).�S�4tar <br />4. Generator's Phone <br />077 <br />S. Transporter 1 Company Name <br />6. US EPA ID Number <br />1/j Ir <br />c_ <br />Q7. <br />Transporter 2 Company Name <br />8P. US EPA ID Number <br />` <br />O <br />10. US EPA 1D Number <br />9. Designated Facility Name and Site Address <br />� M Wk S1�. /�14 M2� f <br />e, %d <br />b• <br />Aol <br />i <br />="iter 2 Admovrledoement of Receint of Materials <br />#' ' PrirMed/Typed Nemo ' Signature ' <br />W s t s <br />W" , 14 Drscrepanry Indication Space <br />f _ <br />A' <br />i <br />f_ 20. Focil' Owner of <br />T Printed/Typed Name <br />Y <br />DISC 8022A (7/92) <br />EPA 8700-22 <br />12. <Cordrters y F 13 zz rq -1 <br />11. US DOT Description (including Proper Shipping Name, Hazard doss, and ID Number} <br />r <br />0.N <br />b• <br />R <br />A <br />C. <br />i� <br />Q <br />r <br />rr^ <br />y.t, Y. <br />Aol <br />i <br />="iter 2 Admovrledoement of Receint of Materials <br />#' ' PrirMed/Typed Nemo ' Signature ' <br />W s t s <br />W" , 14 Drscrepanry Indication Space <br />f _ <br />A' <br />i <br />f_ 20. Focil' Owner of <br />T Printed/Typed Name <br />Y <br />DISC 8022A (7/92) <br />EPA 8700-22 <br />