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u <br />c <br />t <br />s <br />_C <br />r° <br />J; <br />c <br />a <br />e <br />C <br />e <br />C <br />C <br />a <br />0 <br />F <br />l <br />LL <br />Z <br />C <br />V <br />LL <br />rk <br />`a <br />C <br />2 <br />Q <br />1. <br />oc <br />Q <br />U <br />W <br />d <br />W <br />U- <br />0 <br />W <br />N <br />Q <br />U <br />14 <br />Jul 11 03 03:13p <br />arotrrorecr,on rgency <br />Fcwo Nproved OMB No. 2050-0039 (Expires 9-30-99) See Instructions on back of : 6. <br />PI esse print or type. Form designed for use on elite (12-pil ,.writer. 'r •- ;- <br />UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />/ 9 q -7 Manifest Document No. r 2. Page 1 <br />of <br />p.2 <br />Department of Toxic Subsloncns Conlrol <br />Sacramento, California <br />Information in Ike shaded areas <br />is not required by Federal lo - <br />DT$ 8V22A (1/991 <br />EPA 87'7}-22 <br />DO NOT WRITE BELOWAHIS LINE. <br />White. TSDF SENDS THIS COPY TO DT5C WITHIN 30 DAYS <br />To: P.C. Box 3003, Socramemo, CA 95812 <br />JUL 11 '03 15:42 PAGE.02 <br />3 Generot rs N nd Mailing ddress <br />�'�w���R` <br />A. State Manifest Document Number <br />Goy �0 5• N✓V sz1s <br />21477086 <br />S. stole Generator's FD <br />s <br />A. Generator's Phone ( 1 <br />I <br />s ! <br />S. Transporter I Company Nome 6. US EPA ID Number <br />C. Slate Transporter's ID Reserved.) <br />f' <br />si <br />s <br />-' yL <br />D. Transporters Phone <br />r.l <br />s <br />I 7. Transporter 2 Company Name 8. US EPA ID Number <br />E. Slate Transporters ID [Reserve <br />F. Transporters Phone <br />t <br />9. Designated Facility Nome and Site Address 10. US EPA ID Number <br />G_ Slate Facility's ID <br />z r E E N l ?N :FCrZc 1 <br />i -Facility's <br />Phone <br />i <br />J- �i L i i'sL.. 11 Y;'� .� :..� ; L✓ <br />r7 .. <br />C) C) <br />11. US DOT Description (including Proper Shipping Nome, Hazard Class, and ID Number[ <br />12. Containers <br />13. Total <br />14. Unit <br />No. <br />T e <br />I <br />Ouantiy <br />Wt/Vol <br />I. Waste Number <br />C. <br />Srota <br />- (DN -TiCRA. HAZ:;RDCjU:> 1,-1A :TF. LI iiJI <br />222 <br />G;; 0I L, I -,-',ATE R _ - 1.1 D:"4 E l N r. 7 Lj ") T 1_:.=,?' 1 Li <br />i. <br />+; <br />EPA/011ier <br />d <br />b. <br />Slate <br />E: <br />R_ <br />EPA/Other <br />C. T - <br />Stale <br />of <br />EPA/Other <br />R. <br />d. <br />Stale <br />EPA/Other <br />J. Addili... I Descriptions for Materials listed Above <br />K. Handling Codes for Wastes Listed Above <br />15. SpeciaTlPiardiing Instructions and Additional Informatic <br />1..` '` { C f J ,) :I f + lJ eI — (J <br />r!`1F RESP ")00 -46c' -1%5C1( 24 HP. IP <br />1,114GF,L-r:%�RA:'.�LE PET11i;N '1 C; E14E;FP ('UR. <br />Sr <br />>: RP A1.IT1-0R1 EU T':) k15i,�III L1— -E4�'E-T <br />`UE`: (,1.-E'N?' c-_'``.PRIL_,`_ A� <br />16. GENERATOR'S CERTIFICATION: I hereby declare Ihoi the contenlr of,his consignment are fully and accurately described above by proper skipping name and are classified, packed, <br />and labeled, and are in all respects in For by highway <br />marked, proper condition transport according <br />to applicable international and national government regulalions. <br />If 1 am a large quanlity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated ,o the degree I have determined to be economically <br />and that I hove selected the treatment, disposal <br />practicable procticoble method of storage, or currently available ro me which minimizes the present and future threat to human health <br />and the erwlronmenh OR, if I am a small quantity generator, I have mode a good faith effort to minimize my waste generation and select Ike best waste management method that is <br />ovoilable to me and that I can afford. <br />1 <br />Prim /Typed Nome <br />e <br />Month Day Year <br />i Doi (14SItf 12JSignalur <br />O /0 1 Z- a 12- <br />I& Tran %i Acknowledgement of Receipt of Materials <br />a <br />M <br />Prin /T � <br />+ <br />e�'v� S natu <br />Month Day Year <br />P <br />ci <br />q <br />18. Trans otter 2 Acknowled emenl of Receipt of Materials <br />N <br />1 <br />Printed/Typed Nome <br />$i nolure <br />Month Do Year <br />E <br />F <br />19. Discrepancy Indication Space <br />f <br />A <br />C <br />1 <br />L <br />�- <br />1 <br />20. FacilityOwner or Operator Certification of receipt of hazardous materials cavo red b th' <br />i sl l as n din Item 19. <br />T <br />Pri nled/Typed Name r---- <br />Signature / <br />/ <br />Month Day Year <br />4 e 1 <br />DT$ 8V22A (1/991 <br />EPA 87'7}-22 <br />DO NOT WRITE BELOWAHIS LINE. <br />White. TSDF SENDS THIS COPY TO DT5C WITHIN 30 DAYS <br />To: P.C. Box 3003, Socramemo, CA 95812 <br />JUL 11 '03 15:42 PAGE.02 <br />