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Pleasefprint or type (Form designed for use on elfte(12 plch)lypewMer) Form Approved OMB No 2050-0039 Expires 9-30-M <br /> UNIFORM HAZARDOUS 1 Generators US EPA ID No DocumenitNo 2 Page 1 isfnot'required by Federal laws <br /> WASTE MANIFEST D of <br />. 3 Generators Name and Mailing Address A state Manliest Document Number <br /> Wickland Pmpert ea (ft9al 604) 9#? 5$ <br /> P.Q. BOX 13648, Sa .-ramento r CA 95853-4648 8 1 State Generator s 1D <br /> 4 Generators Phone( 916 f 921-1100 (24 hou s) <br /> �5 Transporter 1 Company Name 6 US EPA ID Number fa State Trans rter's <br /> ( � ` � r - s •? � � D Transport PFronk- s° CA Y <br /> 7 Transporter 2 Company Name 8 US EPA ID Number E State Transporler's ID " <br /> f F Transporter's Phone <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number G State Faciltty's ID p <br /> L`a�f8 4A—Z'akf.IIla i �C» 054 <br /> 1414 S. First Street ti Facility's Phone <br /> 509 <br /> 12 Containers 13 14 <br /> 11 US DOT Description(Including Proper Shipping Name Hazard Class and!D Number) No Type QTotalty nit Waste Na <br /> a <br /> Hazardous 1ASte 50134 <br /> N N.Q.S. OPM4 KA 919$ <br /> R b <br /> A 352 <br /> 0 <br /> R <br /> d <br /> 9 <br /> J Additional Descriptions for Materials Listed Above K Handling Codes for Wastes Lfsted Above <br /> PMt cart ca.isttra� need for ver extraotion <br /> with unleaded fuel.- , <br /> e itxlt f i t. Goorge Clot"z-a (916} S&SwS fl#3 <br /> 15 Special Handling Instructions and Additional Information <br /> Stti zdak wd for pwatroolum range hyd roaarnos0ts <br /> 16 GENERATORS CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping <br /> name and are classified packed marked, and labeled and are in all respects in proper condition for transport by highway according to applicable <br /> International and national government regulations <br /> If I am a 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 <br /> determined to be economically practicable and that I have selected the practicable method of treatment,storage or disposal currently available to <br /> me which minimizes the present and future threat to human health and the environment OR if I am a small quantity generator l have made a good <br /> faith effort to minimize my waste generation and select the best waste managemen method that Is fable to me and that I can afford <br /> PnntedlTyped Name Signature Month Day Year <br /> 3�ent for Wickland <br /> GonveT Ise <br /> T 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> A PrintedlTyped Name Signature Month Day Year <br /> P <br /> R 18 Transporter 2 Acknowledgement of Receipt of Materials , <br /> T PnntedrTyped Name Signature Month Day Year <br /> R <br /> 19 Discrepancy Indication Space <br /> IF <br /> A <br /> C <br /> 1 20 Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19 <br /> T Printedl3yped Name Signature Month Day Year <br /> Y <br /> EPA Form 8700 22 (Rev 9 86) Previous editions are obsolete Reorder No 860 Lab Safety Supply Co <br /> GENERATOR COPY <br />