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State off California—Environmental Protection Agency , <br /> Form AlPproved OMB No.2050-0039(Expires 9-30-99) r'. SeeUsi t cons on back of - ''e 6. Department of Toxic Substances Co <br /> Please int or type. for i�designed for use on elite(12 pitch)f tar. . u Sacramento,California <br /> �- "'eM <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> �.._.. <br /> UNIFORM HAZARDOUS -^-y is not required by Federal law. <br /> WASTE MANIFEST C AlL_ 010101 1 !3 8 1131 •3 !� 1. 7 5 of <br /> % <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> C.S.U. STAN1%.ALJS 23534765 <br /> 1252 NURTFI STANISL_AU7 B. 5lafeGenerofor'siD <br /> o STICK T ON CA • 5P.61 <br /> 4. Generator's Phone Rec) <br /> fV 5. Transporter 1 Company Name 6. US EPA ID Number C.Slote Transporter's.ID Reserved.] <br /> h <br /> D. Transporter's Phone' <br /> C) Ofd-D E:NVTFiOMENTAL.. &E;NF K-Y INC C: AIR (:l 0 O C1 i '� 8 i (916)371-36T. <br /> 8. US EPA JD Number E.:State Tr <br /> �- Z. Transporter 2 Company Name _ - - -.- __- -- • nntportec`s.ID[Resented-' <br /> PF. Transporter's-Phone } - <br /> Q <br /> U 9. Designated Facility Name and Site Address10. 5 ID Number �G. State Focility'siD <br /> �A CC _aAW-4464A"111i,_*1110A - 7 Faciliy's"Phone a , <br /> t.�o HOW 63 i6hi V4c41 V KL A96 Y <br /> ')Q 12. Containers 13. Total 14. Unit <br /> V U 1 1 US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol I. Waste Number <br /> +.1) ASW.'S I US, 9, Nf��:_'i?7-i', FK.i 1 11 (NAF_.R'G#J.?1 �y� State 151 <br /> C��.n't <br /> 3 G 0101 <br /> r © EPA/0"O/M <br /> O N b. State <br /> co E` EPA/Other <br /> v R <br /> A c State <br /> o T <br /> 0w O <br /> R EPA/Other <br /> LU <br /> w State <br /> d. <br /> Z <br /> V EPA/Other <br /> w <br /> rn J. Additioo6l Deicrhitions#arMate'ria6 Listed Above K. Handling Codes for Wastes listed Above <br /> Z b <br /> r, <br /> I . <br /> r. C J. <br /> J <br /> Q <br /> Z 15. Special Handling Instructions and Additional Information <br /> Q i { H(ALJk!'� E_h#L_R6E.N0 ## (916)3f71.-136J.7.LPA RL610N 1.Xj'PH h_E_.01UN IX RLUION <br /> 801: #MD J -41 F�RANCIFCO L . 34 "Z X4 : LJf � J ( rkrl1_ 1t01ENT <br /> w 4RFR61., (AA(;GEb,SE:AL.FF) <br /> L.ATsL:I_E:1)) <br /> Job Nz�nt-: G.S. !-#Im1SI_lus, ,yob ## 5195 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment ore fully and accurately described above by proper shipping name and are classified,packed, <br /> < marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and notional government regulations. <br /> If I am a large quantity generator,I certify that I have a pr ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically e <br /> a practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threaYtb human health <br /> rn <br /> and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> available to me and that I can afford. <br /> O P{r' ted/T a amp <br /> ) Si __ Month Day Year <br /> 7 y. <br /> 01 <br /> 0 T 17. Transporter 1 Acknowledgement of Recei I of Materials <br /> LU A Printed/Typed Name ���{..7� Signature Month Day Year <br /> W s L?. ti 1016 <br /> w 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> 8 0 Td <br /> /Typed Name Si9 nature Month Day Year <br /> Printe <br /> LU E <br /> rn R <br /> Q <br /> U 19. Discrepancy Indication Space <br /> Z f <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Foci ity Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> Printe / d N me Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> (Generators who submit hazardous waste for transport out-of-state, <br /> DTSC 8022A (1/99) produce completed copy of this copy and send to DTSC within 30 days.) <br /> EPA 8700-22 <br />