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�.1. <br /> t5tote of California�Environmental Protection Agency <br /> Form Approved OMB No.200-0039(Expires 9-30-99) See Instructions on back of r^Qe 6. Department of Toxic Substances Control <br /> PI or type. form designed'for use on elite(12-pitch) iter. Sacramento,California <br /> TI - 1. .generator's US EPA ID No- Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal law. <br /> WASTE MANIFEST �, �j ( of <br /> 3. Generator's Name and Mailing Address <br /> In et State Manifest Document Number <br /> �� ��. � �-v ti 9725/945 <br /> �, ►. N� , <br /> B. State Generator's iD <br /> $fuG,. ort <br /> `h A. Generator's Phone <br /> n <br /> N 5. T'raannsportteerr 1 Comparnyy Name 6. S EPA ItR NUmlier State Transporter's ID �^ <br /> �" ��r :/?;:, D: Tran Spatter's Phone q �"y' ^Y 7� •r'Lis <br /> ry al)iLffv. ;/, <br /> 7.'..TransporF 2 Company Nome &a US EPA ID Nurhbir - E` SfaieTrnn'sporfer's I <br /> ' F. Transporter's Phone= <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Fdc*lity's D <br /> �iV C�4f�U hone <br /> 12.tConjlainers13. Total 14. Unit <br /> U16 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No Quantity Wt/vol I: Waste Nucl�imber <br /> a' [� �.f! (1�/S" .�''�/ S �(� State <br /> V3: <br /> vlEPA/Other <br /> G ,! r, d I IT 001 RIQ - <br /> c�i E kt* r e ( State' <br /> O N <br /> co <br /> 00 E• EPA/Other <br /> v R <br /> CV <br /> � A c State <br /> o ' rt <br /> Q EPA/Other <br /> R <br /> 04 <br /> AI $ra� f <br /> t"'t- d. 4 <br /> Z <br /> LU EPA/Other <br /> V <br /> NgK: Handling Codes for Wastes Listed Above <br /> J. Additional Descriptions for Materials Listed Above <br /> . -• <br /> G/.. -g <br /> Q. <br /> b <br /> QC. <br /> Z 15. S ectal Handl* Ins uct* ns nd dirily�informati n <br /> 4 Vt Su v1 ey /'rc cry.��vtS <br /> Z' 4w� <br /> W <br /> '46t,- <br /> 16. GENERATOR'S ERTIFIC TION: I hereby declare that the contents of this consignment are fully and accurately described.a}wve by proper shipping name and are classified,packed, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable interxltiTional and national government regulations. <br /> IF I am a large quantiy generator,I certify that I have a program in place to reduce the volume and toxicity of wastegenerated to the degree I have ermined to be economically <br /> CL practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present an,,�jjure threat to human health <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 w641lMhanagement method that is <br /> Ut available to me and that I can afford. <br /> O Month Day Year <br /> Printed/Typed N me Si nature <br /> w T 17. Transporter 1 Acknowledgement of R cell t of Materials ~ <br /> R MonTlt Day Year <br /> 04 LU <br /> Printed/Typed Name Signature �y <br /> I N / <br /> S ^ s <br /> 4y P <br /> u p 18. Transporter 2 Acknowled em nt of Receipt of Materials <br /> CJ 1R Printed/Typed Name Signature Month Day Year <br /> LU <br /> U 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> 20. Facility Own% or Operator Certification of receipt of hazardous materials covered by this ritanifest except as noted in Item 19. <br /> j Printed/Type me ,� Signature Month] Day Year <br /> Y C� f Y t•►t- C 7 Q <br /> DO NOT WRITE BELOW THIS LINE. <br /> „JY Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> P (Generators who submit hazardous waste for transport-out-of-state; <br /> DTSC 8022A (4/97) produce completed copy of this copy and send to DTSC within.30 days.) <br /> EPA 8700-22 <br /> r <br />