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State of California—Environmental Protection Agency See Instructions On back Of ' -e 6. Department of Toxic Substances Control <br /> Form Approved OMB No.2050-0039(Expires 9-30-991 Sacramento,California <br /> Please print or type. Form designed for use on elite(12-pikh)t, Mr. <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by federal law. <br /> 7 of L <br /> WASTE MANIFEST ( j �j J �� 7 '�) {) <br /> 3. C9 9iFAJq&e and Mailing Address A. State Manifest Document Number 21704591,p .9 ry F�.•/vy <br /> 685 W. Third St /Jit I! As zi V^VM <br /> Hanford, CA 93230 B- Slate Generator's ID <br /> 555 593-3251 <br /> 4. Generators Phone I I <br /> N 5. Transporter 1 Company Name 6. Us EPA ID Number C. State Transporter's ID Reserved.[ <br /> h 2, <br /> m <br /> 0 Filter K4CyCl lnOf ie fv lne�s IITO� 9 S 4 4h 1 D. Transporters Phone l�'= I at '•L J.G <br /> O <br /> OP 7, Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] <br /> I J F. Transporter's Phone <br /> a G. State Facility's ID <br /> t U10. US EPA ID Number <br /> ) 1 ig.39e3i9nPta:l FLKiGQ"-�2".IPf2,''�.`-t9Sl�f't�'3 a:�t-,ritC�u4'- <br /> d 180 W. Honte Ave. <br /> k o Rialto, C4 92315 C. ,2. <br /> A D >k 8 2 4 4 4 4 9 1. H- FaciliV,Phone 4909;421-201 <br /> 0 <br /> =eQV.6ty <br /> 14. Unit <br /> f U 11. US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number) 'c Wt/Val I. Waste Number <br /> Za. - ... .. .. -2 <br /> U EPA//Other <br /> G <br /> E State �— <br /> o N 6. <br /> m E EPA/Other <br /> v R <br /> A c State <br /> o T <br /> m O EPA/Other <br /> R <br /> y- Slate <br /> w d. <br /> N <br /> Z EPA/Other <br /> W <br /> U <br /> W <br /> K. Handling Codes for Wastes listed Above <br /> N J. Additional Descriptions for Materials Listed A6ova 8 <br /> 6. <br /> O stJ�) t+r35ud'hcl�r / � ; tt4�x} <br /> a d. <br /> as: c. <br /> J i <br /> a , <br /> Z Rt4: 6<iatt!'an8i7og9A1bu'cts b'Sa !\ITdBionol Information X/T1 1.0--AT1O'fi: � L'i-T•�.r v.(• Y' i %'Ul- <br /> a 'L4 tZR E2'4^R.GEtd�'i $:?l1f!-;i1-2012 3C' Sv.l - <br /> Z <br /> - L a^.1 s CA <br /> w <br /> S <br /> H <br /> 16. GENERATOR'S CERTIFICATION: Ihem6y declare that the contents of this consignment are fully and accurate)y described above by proper ship�ing name and are classified,packed, <br /> Umarked,and labeled,and are in all respects in proper condition far transport 6y highway according to applicable international and notiana government regulations. <br /> '-' If I am v large quantity generator,I certify that I have a proggram in place to reduce the volume and toxicity of waste generated to the degree I have determined to 6e economically <br /> a practicable and that 1 have selected the practicable method of treatment,storage'or disposal currently available to me which minimizes die present and future threat la human health <br /> and the environment;OR,if 1 am a small quantity generator,I have made a 809d Faith effort to minimize my waste generation and select the best waste management method that is <br /> waila61 t me and that I ban afford. !) t <br /> O I t Month Day Year <br /> y Printed/Type N ma Signafurei 1 I t <br /> U <br /> z" <br /> w T 1Y. Transporter 1 Acknowled emant of Recei t of Material <br /> R Si afore '?' Month Day Year <br /> d' ,E Printed/Typed Name un /` <br /> w 1 18. Tions arter 2 Acknowled cumn t of Recei t of Materials <br /> -; <br /> O T Printed/Typed Name Signature ' Month Day Year <br /> w E <br /> h R <br /> U19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> 20. Facili Owner or O orator Certification of recei t of hazardous materials covered b this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/991 Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />