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c <br />C <br />C <br />c <br />C <br />C <br />a <br />a <br />U <br />t - <br />U <br />U <br />Q <br />LL <br />L <br />C <br />V <br />LL <br />a <br />L <br />C <br />a <br />2 <br />LL <br />F- <br />4 <br />L <br />a <br />U <br />C <br />} <br />LLL <br />Z <br />C <br />U_ <br />LL <br />LL <br />C <br />LL <br />Q <br />L <br />'.State of California -Environmental Protectio iii <br />Form Approved OMB No. 2050-0039 (Exp30- �•/t, <br />Please print or type. Form designed for use on elite (12 pitch' sWrd <br />DO NOT WRITE BELOW THIS LINE.-_ <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />Green: TRANSPORTER RETAINS <br />UNIFORM HAZARDOUS <br />enerator's US EPA ID No Mantfeif ffxumen g stn rmatitinryn <br />�`WASTE <br />MANIFEST <br />� > 1', Is not requj ed f$ <br />777 <br />3. Generator's Name and Mailing Address <br />1/2 <br />A State Manifest Document Number <br />t. - <br />14,1111 <br />0 <br />r) <br />t tf �-^ <br />B. State Generator's ID <br />4. Generator's Phone- <br />'t..'� <br />`t <br />5. Transporter I Company Name .= 6. US EPA ID Number <br />C. State Transporter's ID [Reserved.] <br />0 <br />u n.�,•Y ;f:u 1 a EI 3YZT M It'IC. CR ' 000 <br />" _7c1"t3 <br />D. Transporfer's Phone <br />- <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />800 669-5894 <br />E. State Transporter's ID [Reserved.] <br />j <br />( <br />J <br />F. Transporters Phone <br />9. Desi noted Facility Name and Site Address <br />g h 10. US EPA ID Number <br />G. State Facility's ID - - <br />050144 <br />C D -�I g <br />n050.144 <br />7� JOSE), <br />A FE V. -Yl! �.iry) ( SAN 'J VJ�i / , I <br />- <br />1d?21 9E2I YESSA RLQ CAD059494310 <br />H. Facility's Phone <br />SAN JOS' CA 95133 <br />800 543-3558 <br />j <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number( <br />12. Containers <br />13. Total <br />14. Unit <br />No. <br />Type <br />Quantity <br />Wt/Vol <br />I. Waste Number <br />NON -Pi -,AA AA r -UI L ARDOUS ]^lt STE L.I QUID <br />'31.UDGE <br />State <br />222 <br />G <br />., %k?AT ER , ( NOT DOT REGULATED) <br />TT <br />G <br />EPA/Other <br />� <br />' N <br />b. <br />State <br />� E <br />R <br />EPA/Other <br />A <br />T <br />c. <br />State <br />O <br />R <br />EPA/Other <br />d. <br />State <br />EPA/Other <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes for Wastes Listed Above <br />a. 14 b. <br />15. Special Handling Instructions and Additional Information <br />Ml''ST R%T#000000000 0-000'-00 <br />RESP 800-468--1760( 24 HR ? . Sr UNDELIVERABLE RETURN TO GENERATOR, <br />AZ=ms110R LIED TO RETA1IN ;1AICENSED SUBSEQUENT CARRIERS AS' NECESSARY. <br />SBC lOT 1- <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are Fully and accurately described above by proper s"ppoving name and are classified, packed, <br />labeled, <br />marked, and and are in all respects in proper condition for transport by highway according to applicable international and national gernment 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 economicallyy <br />practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human heolth <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 Name <br />I <br />Signature .-7 <br />Month Day_ Year <br />T <br />It <br />17. Trans oder 1 'Acknowledgement of Receipt of Materials I / <br />A <br />Printed/Typed Name �Fv- <br />'Signature Tv" <br />Month Day Year <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />R <br />E <br />Printed/Typed ed Name <br />YP <br />Signaiure <br />Month Day Year <br />,, <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />L <br />F ility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br />T <br />r20. <br />lrinted/Typed Name <br />Signature <br />F Month Day Year <br />DO NOT WRITE BELOW THIS LINE.-_ <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />Green: TRANSPORTER RETAINS <br />