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C <br />2 <br />LL <br />C; <br />ck <br />ILLLL <br />C <br />LL <br />v; <br />Q <br />U <br />fi <br />crate or Lai itornio—Environmental ProtecfioiNtg g' ,_lg <br />Form'Approved OMB No. 2050-0039 (Expires 4 30 9 j1 u <br />Please print or type. 'Form designed for use on eGie 111-r , - „fi v '11 <br />DO NOT WRITE BELOWTF�15` LINE._ <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />Green: TRANSPORTER RETAINS <br />UNIFORM HAZARDOUS 1.=Generoror y US EPA IDN Man ITNRmenfN ' r <br />On. <br />" <br />WASTE MANIFEST { _ :, ri r , •las riot regwrby FeMITI" ' <br />3. Generator's Name and wloiling Address A <br />$tate Mamfesf Document Number-4• <br />umber �,TV <br />h. <br />`� 4 <br />V <br />L B. State Generator's ID <br />`0 <br />�R �q f y� <br />4. Generator's Phone ( ) S 1 <br />(V <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporters ID [Reserved.] <br />00 <br />O <br />O <br />a I? + - • i+t':.:. i.'ti .fii Ti s' u INCx G . t+ C'1 <br />bR 0007 Q <br />D. Transporter's Phone <br />7. Transporter 2 Company Name <br />800 669 0 <br />J <br />8. US EPA ID Number <br />E. State Transporter's ID [Reserved.] <br />J <br />Q <br />F. Transporter's Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State ID$ <br />n <br />z <br />ti.�x•�^- cL:�� ; seta Ju°z4i <br />�5EIZRYE;S:A <br />`02! RD CAD059494310 <br />—SAN <br />H. Facility's Phone <br />J <br />�;uSE CA 95133 <br />800 545-3358 <br />J <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number( <br />ntainers <br />13. Total <br />14. Unit <br />Tye <br />Quantity <br />Wf/Vol <br />I. Waste Number <br />iJ a'7 Z.C't�i O[.l vA.Si WASTE' LIQUID <br />INA , <br />LNN <br />State 2 L <br />G <br />01L R, yLUDGE NOT DOT REGULATED) <br />TT <br />G <br />. <br />EPA/Other <br />E <br />._ <br />V <br />b. <br />E <br />State <br />7 <br />EPA/Other <br />A <br />T <br />O <br />C. <br />State <br />o <br />- R <br />EPA/Other <br />C <br />d. <br />State <br />i <br />EPA/Other <br />J. Additional Descriptions For Materials Listed Above <br />K. Handling Codes For Wastes Listed Above <br />r <br />14 b' <br />i <br />t/ f1 a <br />c <br />d <br />j <br />15. Special Handling"In3iructions and Additional Information <br />t_'I?tII.L4 3° , o_ .��.. MF'ST R./T4000000000 0-000-0v IVI 70 <br />t2Cw� 8013-46 1 ; 60( 24 HR) IF UNDELIVERABLE RETURN TO GENERATOR. <br />SX CORP A��rtHOR,12JED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY. <br />crvnrirrg <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 labeled, 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, xertify 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 />have <br />practicable and that I selected tie 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 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 />Printed /Typed Nome Month Day /Year <br />Aj <br />T ' <br />R <br />I T Trans orter 1 Acknov led ement of Recei f of Materials ^ <br />N <br />Printed/Typed, Name ^--` <br />Signature ' r i' <br />Month Day Year <br />h„f P <br />0 <br />R <br />18• Transporter 2 Acknowledgement of Receipt of Materials - ^ <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />L <br />1 <br />20. Facility Owner or O erator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br />T <br />Printed/Typed Name <br />Signature 1 .) ( <br />Month Day Year <br />DO NOT WRITE BELOWTF�15` LINE._ <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />Green: TRANSPORTER RETAINS <br />