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rA <br />wwu�nuu—�",monmenrai rralBCYfan"Agenc,Y` r,(, <br />form �1prevecl OMe No. 2050-0034 (F><pires 4��0 9pj RMIMAasee print# type. Form designed for qse on elite (2 prlc � t: b >' <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) <br />EPA 8700-22 Green: TRANSPORTER RETAINS <br />UNIFORM HAZARDOUS enerator's. US EPA ID No �lmenF <br />nrrst( <br />eYN <br />WASTE MANIFEST CAL0002Z347 <br />is noortt <br />eur�a�njarw <br />tr++�whr <br />3. <br />trs <br />Generator's Name and Mailing Address i d 1. <br />6540 S AUSTIN! <br />A Slate Manifest Document Number, <br />DA17E ; <br />y. <br />�}%. <br />O <br />fSARLO'M <br />4 N <br />;~ <br />CA 95215 - - <br />"`�r� <br />B. State Generator's ID <br />LO <br />4. Generator's Phone ( 2 0 9) 460-6021 <br />r <br />- t <br />- <br />LI)N <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter's ID [Reserved.] <br />00 <br />6 <br />AFEiY-K171"EN SY,'cTE S I1dC. SCR00007 S 250 <br />, <br />D. Transporter', Phone <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />,.800 669-5840'_ <br />J <br />E. State Transporter's ID [Reserved] <br />J <br />Q <br />F. Transporter', Phone <br />9. Designated Facility Name and Site Address <br />0501.44 10. US EPA ID Number <br />G. State Facility's ID <br />E <br />�;F:.:'Er: `�- '-'I I it CiiiF JCS 'E) I <br />C 0 4 94 1 <br />Y <br />D <br />1 fJ L 1 % urt i 1. J :11� Q[ fElac"Ity.s <br />CAGG54n94310 <br />Facility's hone <br />SA14 fj0S;E CA 45133 <br />80fJ `�45 -3358 <br />11. US DOT Description (includingProper Shipping Name, Hazard Class, and ID Number12. <br />P P PP g <br />Co13. <br />Total <br />14. Unit <br />No.Quantity <br />Wt/Vol <br />I. Waste Number <br />a._,]01C—RA Ht%L71JARDOUS .WASTE LIQUID <br />Stare,. <br />DOT REGULATED,.:, <br />222 <br />EEPA/Other <br />� <br />14 <br />N <br />b. <br />State <br />oE <br />R <br />v R <br />EPA/Other <br />7 <br />jT <br />c. <br />State <br />O <br />R <br />EPA/Other <br />d <br />State <br />J <br />EPA/Other <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes for Wastes Listed Above <br />t <br />a b. <br />14 <br />t <br />e -- . �"� }f <br />e <br />d. <br />E C <br />✓ <br />j <br />15. Special Handling Instructions and Additional Information <br />MFST R.iT#101704868 0002-69'3-98 <br />EMERGEN"r-Y »ESR 800-468-1760( 24 Hit ?. IF UNDELIVERABLE RETURN TO GENERATOR. <br />N]: Cr`"I" AU711'OR:Z"ED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY. <br />c;rr <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 />Mor mked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and <br />not,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 rracticable method of treatment, storage, or disposal currently available to me which minimizes the and future threat to human health <br />present <br />and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generotionfand select the best waste management method that is <br />available to me and that I <br />can afford. <br />Printed/Typed Name , -- <br />l r <br />Signatures f r <br />Month Day ,,. Year <br />T <br />R <br />17. Trans orter 1 Acknowled ement of Receipt of Materials <br />A <br />Printed/TypedName Signature,--.. – <br />Month DayYear <br />P <br />a <br />A <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />T <br />E <br />Printed/Typed ed Name <br />YP <br />'" <br />Signature <br />Month Day Year <br />A <br />19. Discrepancy Indication Space <br />F <br />A <br />L <br />1 <br />20. Facility Owner or O erator Certification of receipt of hazardous materials covered by this maA– est except as noted in Item 19. <br />T <br />Y <br />Priglgd/Typed Name _ _.. <br />i <br />Signature. ���j ` <br />�j // <br />Month Day Year <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) <br />EPA 8700-22 Green: TRANSPORTER RETAINS <br />