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State of Cal#fomia—Environmental Protection Agency <br /> Form Approved OMB No.2050-003Q(Expires 9-30-99) See Instructions on back of page 6. <br /> Please print or type. Form designed for use on elite(12-pitch)typewriter. p 9 Department of Toxic California Control <br /> Sacramento,California <br /> Ir i. Generator's US EPA!D No. Manifest Document No. L2. Page # Information in the shaded areas <br /> UNIFORM HAZARDOUSis not required by Federai low. <br /> WASTE MANIFEST 1 a3. Generator's Name and Mailing Address ,� f C { fe' y,a r 4qocument Number <br /> 1150646 <br /> B. State Generators fD <br /> Ln A. <br /> Generator's Phone J ` �"` 05 r <br /> SV 5. Transporter 3 Company Nome US EPA iD Number C. State Transporter's iD[Reserved.) <br /> p ML:RICAN VALI. Y VIf.A ,1TE Olt. s7 D. Traniporter's Phone '�•.'i' 32-164ai <br /> ' O <br /> 7. Y Name Transporter 2 Com an N <br /> P P 8, US EPA ID Number E. State Transporte/s ID jReserved.1 <br /> J <br /> Mr <br /> Q F. Transporters Phone <br /> Q � f V f""A 3:c€,to mos & 's 10. US EPA IA Number G. 5 F iii s Ir r <br /> " 4 ! i <br /> t Z 300 Lrt",�I,,,I ROAD <br /> d' .H. Facility's Phone <br /> J <br /> Q 12. Containers 13. Total 14. Unit <br /> V 11. US DOT Description[including Proper Shipping Nome,Hazard Class,and ID Numbed <br /> Z a q X..x"i4's!.C4'+..i' No. Type Quantity Wi/Vol It. Woste Number <br /> z O'�``�-RCRA�H9�- WA37C Lf1.40r, Slate 21 f <br /> 3 G {) EPA/Other <br /> a.. o N b, state <br /> amo E <br /> R EPA/Other <br /> C14 A <br /> i.. a T <br /> Stare <br /> m O <br /> R EPA/Other <br /> ae <br /> LLJ t- d- Stare <br /> Z <br /> LU <br /> V EPA/Other <br /> w LL <br /> 11 J. Additional Descriptions for Materials listed Above K. Handling Codes for Wastes Listed Above <br /> OILY WAFER <br /> LU <br /> b- <br /> w <br /> C. d. <br /> J <br /> Z 15, Special Handling Instructions and Additional Information <br /> PZ <br /> I+r <br /> a Ct'OVl 9 <br /> LL, <br /> tlr � <br /> 1 16, GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurate)y described above by proper shipping name and are classified,packed, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> If I am a large quantity generator,I-certify that E have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be ecanomicolfy <br /> it CL practicable and that I have selected the practicable method of treatment,storage,or disposal currently avoilahle to me which minimizes the present and future threat to human health <br /> and the environment;OR, if l`om 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 /> PritedJTyp amsSignor e j J, Month Day Year <br /> Lrs R nte17. Transporter 1 Acknowled ement of Receipt of gterigls <br /> W p Prid/Typed,pFelf�e Signature Month Oay Year <br /> w S L) ��^ t <br /> P <br /> y U- 0 1$. Transport r 2 Ackn led ement of Recei f of Materials •" <br /> TPrinted/Typed Name Signature Month Day Year <br /> LU E <br /> a <br /> R <br /> V 19. Discrepancy indication Space <br /> +..Z F <br /> A <br /> C <br /> f <br /> L <br /> l 20. Fccility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> 6r ''T Printed/Typed Name Signature Month Day Year <br /> t. <br /> DO NOT WRITE BELOW THIS LINE, <br /> DTSC 8022A 11/99) Yellow: GENERATOR RETAINS <br /> EPA 8700---22 <br /> a✓ <br />