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Slate of Colifornio—EnvironrnenWl Proleuion Agency <br /> TForm Approved OMB No.2050-0039(Expires 9-30-94) See Instructions on back` � <br /> Please print or type. Form designed for use on elite 12- tZr a9e Department of Toxic Substances Col. <br /> f Pi ewrirer. <br /> Sacramento,California <br /> UNIFORM HAZARDOUS 1• Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST � q e a o y. 7 0 0 6 8 7 of <br /> ! is not required by Federal low. <br /> 6 <br /> 3. Generator's Name and Mailing Address �/� <br /> 6 urb a,1 7r'/�D��a�1 A 2 State Maryfmt.Docur� ddurnben.Mlsx5r� , <br /> low <br /> h4. Generator's Phone (wQStatq <br /> ao /- g3 — s"� Ma S 7 <br /> d 5. Tronsporter 1 Company Name <br /> b. US EPA D Number <br /> OP CAD982438566 F { <br /> Dexanna Ltd. t <br /> 7. Transporter 2 Company Nome <br /> Q 8. US EPA ID Number Es SfSthr4tlsFwrr�,}�.e;+r�'T �[p S ss; <br /> F Tr�xosa <br /> Q 9. Oei aced acilify Na a and Site Address + <br /> Z r.r1C SdT1,1I1C. 10. US EPA ID Number dG Stcr�a a�t41�'ylR t ��.�MA � <br /> P—IM <br /> O 255 Parr Blvd. s <br /> `*r ter: <br /> "�Q Richnnnd,CA. 941301 kHI>faaGty`'Phtih v s <br /> Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12- Containers 13. Total 14. Unit <br /> No. T Quantity Wt/Vol (• p;t0 fie( ,�ti; <br /> a- NCN-RCRA Hazardous Waste Solid <br /> Waste Flnpty Storage Tank. O Q I r P p 01 <br /> 00 N b• d.S d <br /> n R tf` xFR,�'`7:�'wK , <br /> `t A EPA/Other„ " T7 <br /> o T C. <br /> 0? Q <br /> W <br /> Z d. <br /> U f _ e rt <br /> M.!r�•t�- <br /> w =.;. SPA/4►fpr �3 <br /> i tFY <br /> off, r ,q. ti <br /> (;luted ApoYq�s �" y,, K Handling Codes for Wa{fesUj <br /> Ltstpd �r r+k A s`r` <br /> mer S S }l�S7L" f+rFcal 121E'Z'tf ttl:. <br /> 15 <br /> Z r / `. mwtx+ ? xr 7rYti7r °ta <br /> ; 3cek> ?e „1000 �ailon Capacity d <br />® s c n <br /> LS.. z t.r`'.en`s -' t c•� .:3 k a... xJ,X��a�t r:j( f�e.11 snli 'r•�i�«-- <br /> i. <br /> 0 15. Special Handling Instructions and Additional Information <br /> Keep away from sources of igniwa swear ha ats en working around f <br /> z U.G.S.T. 's 24 Hr. Contact Name, i & Phon <br /> z <br /> J 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, <br /> Upacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> JIf I am o 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 <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> CL threat to human health and the environment;OR, if I am a small quantity N q ty generator, I have made a good faith effort to minimize my waste generation and select the best <br /> Waste management method that is available to me and hat an afford. i <br /> 0 ' ted/Typed Name <br /> e �' nature _ Month Day Year <br /> U l <br /> Z t . Transporter I Acknowledgement of Receipt of Materi s <br /> R <br /> LUA Printed/Typed Name Signature / Month Day Year <br /> Uj : L. F. DeKalbLc � Ci <br /> P <br /> 0 18. Transporter 2 Acknowled ement of Receipt of Materials <br /> w T Printed/Typed Name <br /> Signature <br /> E Month Day Year <br /> O <br /> R <br /> LU 19. Discrepancy Indication Space <br /> Q F <br /> VU A <br /> Z C <br /> 1 <br /> 1 20. ocili Owner or Ooert3tdr Certification of receipt of hazardous materials c vered b this in i est exile r as noted in Item 19. <br /> T Pr ed/Typed Name 1 Sign )Ure Month Day Year <br /> DO NOT WR E BEL+ TFO INE. <br /> I <br /> DTSC 8022A (9,+93) <br /> EPA 8700-22 <br />