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5fote of Cahforrno^Environmental Protection Agency <br /> Form Approved OMB No 2050-0039(Expires 9 30 991 See Instructions on back of page 6 e <br />' P 9 Deportment o{Toxic Substances Control <br /> Please print or type Form designed for use on elle(12 pAcb)lypewnler Sacramento California <br /> UNIFORM HAZARDOUS 1 Generator s US EPA ID No Manifest Document No 2 Page 1 Information in the shaded areas <br /> u not required by Federal law <br /> WASTE MANIFEST {- t r} iii ii; ! E ; t e-, O' <br /> 3 Generator s Name and Mulling Address A State Mamfeis curnerit'Numbor <br /> 7 w ! tri `:. y x �� '+� �" ' <br /> !_'J(��i�¢ �r yyy s c 1 y� y f �y,� r B State Generctoris IDTt ;?A,;d�yrr� <br /> C7 / 14Mf t r'7} .}I I ?14lCK F(JN (-+A ��st ��r} S*� `��i� yr-'r'� �� ATX c� '� +��� <br /> 4 t'ieneraror s done I �� ;. �� <br />'('4 5 Transporter 1 Company Name 6 US EPA ID Number r fsp $, <br /> co <br /> C:1 D Triinsponeco <br /> r's <br /> 7 �ansporler 7Company Nome B' 1A EPA 10'N r'ribi Transporter � i <br /> M <br /> < 'F,TranspprtersPbvne,"` i." ,�°;�r�'`'�'',."'E7 "' <br /> DU 'r �...tw n ?.e sT.`x' ., ''srs. .� .,.'h i.' r „" . <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number ii State FocirjVs ID <br /> Z air l F�� .`9 <br /> FAN WC. t. Y r�i r 1 �� �; s � ���3�4 "1 q <br /> � <br /> .157 Ali x <br /> f e, � �s� �I,.,i��f' ��;C-� H_Faediry s Phone " "t <br /> O <br /> Q 12 Containers 13 Total 14 Unit �' -' 4 <br /> V 11 US DOT Description(including Proper Shipping Name Hazard Class and ID Number) {� { „ <br /> No Type Quantity Wt/Vol f "Wnata Number ;� <br /> z a I (A4 RCEP I;�f�+. f���OOk 1{) VIA', I r I totIF r s�e,e -��t`ti�°�w��x <br /> 3 Ca 400- & WAl ffC} t r EPA/011ier <br />'N E r �_ _ <br /> O N b r 1 s + State <br /> o°po E r k ' .'7, <br /> R EPA/Othf erg "�fi ' <br /> _+ � ri <br />' A c State <br /> W O <br /> R EPA/Other> <br /> w d <br /> Z <br /> LU _ <br /> LU ^ <br /> J Additional Descriptions For Materials Listed Above <br /> y �+y �+�P7��#�(p�y K Handling Codes for Wastes Listed Above <br /> T'4�i�♦eL�L�'r!!8T'llf �� - it r „-t J' _ ,r <br /> r= w b s", r ,k �)R <br /> ;4 <br />'O 15 rSpecial Handling Instructions and Additional Information <br /> Z M'114't G PIA I !-i 11l -f 1 1V <br /> --f+QV 144-Y { 1 TN 7 rJ, <br /> rLU <br /> L F {vr (-r I/ 1 <br /> 16 GENERATOR S CERTIFICATION I hereby declare that the contents of this convgrment ore fully and accurately described above by proper shipping name and are classified packed <br /> < marked and labeled and ore in oil respects m proper condition for transport by highway according to app icoble rnternotioncl and notmnc government regulations <br /> 4 If I am 0 large quantity generator l certify Ifiat I hove a program in place to reduce the volume and toxicity of waste generated to the degree I hove 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 health <br /> and the environment OR I I am a small quantity generator I hove mode a good faith effort to minimize my waste generation and select the best waste management method that is <br /> a ovadable to me and that I con afford <br /> 0 <br /> r Panted/Typed Name Signature Month Day Year <br /> Z 1 r <br /> w <br /> (.7 T 17 Transporter 1 Acknowled emeni of Receipt of Materials <br /> A <br /> LU N Panted/Typed Name r l Signature ' Month Day Year <br /> LU P <br /> sz 0 <br /> 18 Transporter 2 Acknowled ement of Receipt of Materials <br /> 0 T Printed/Typed Name Signature <br /> Month bay Year <br /> w -TE <br /> � R <br /> Q <br /> V 19 Discrepancy Indication Space <br /> Z F <br /> — A <br /> C <br /> I 20 Fault Owner or Operator Certification of recei t of hazardous materiols covered by this manifest except as noted in Item 19 <br /> Printed/Typed Name Signature Month Dory Year <br /> f <br /> DO NOT WRITE BELOW THIS LINE <br /> DTSC 8022A (1/99) <br /> IEPA 8700-22 Yellow GENERATOR RETAINS <br />