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ronmental Protection Agency <br /> Jo 2050-0039(Expires 9 30 99) See Instructions on back of page 6' Department of Toxic Substances Cortrc Farm designed for use on efete(12 prtchJ ty-gwraer Sacramento California <br /> UNIFORM HAZARDOUS C nerator s US EPA ID No Manifest Document P 2 Page 1 I Information in the shaded areas <br /> WASTE MANIFEST L �/ j L / �/ �� r� ofd snot required by Federal law <br /> 3 Generator s Name and Mai i Address A Slate Manifest Document Number <br /> r �MAINA PWL) { ' C.`-`r'n-'yf'a 20954450 <br /> 1 1t u o N 5 L L L�L,,e A �cJ, l( Te-iA ( J�'' 9-�" t� <br /> i � 8 State Generator s ID <br />' ^ 4 Generators Phone I i1 T r-� C �, •) +�J <br /> CV 5 Transporter 1 Company Name <br /> LO t/ 6 US EPA ID Number C State Transporters ID[Reserved] I <br /> O w�`tZ%i'yit�r iti sW pt L&1 Wn�i Er vYw. L v s u D Transporter s Phone 800-732-4S4,5 <br /> �� . �� � <br /> O <br /> 1�OP 7 Transporter 2 Company Name <br /> ..._ P p Y B US EPA ID Number E Slate Transporter's 1D[Reserved J <br /> Lo <br /> Q F Transporter s Phone j <br /> U 9 Designated Facility Name and Site Address 10 US EPA ID Number G State Fociliy s ID <br /> qt*'-e NOUu I klAl; i:t�v1(. Uig 4u, im, 16 U 5 4 5 i 6 � <br /> 4� H Faahy s Phone <br /> n r°x i�, "vd <br /> UI 1 US DOT Descript.on[including Proper Shipping Name Hazard Class and ID Num6er) 12 Comamers 13 Total ?A Unit <br /> No Type Quantity Wt/Vol t Waste Number <br /> T a NON-RCRA HA7ARr*100,<N WASTE 1101116 State <br /> 2a1 <br /> 3 G OILY Ihrr�r�� 1 r) r� t I r � EPA/Other <br /> 1 E <br /> O N b State <br /> co E <br /> N R EPA/Other <br />' v A <br /> o r <br /> O State <br /> R EPA/Other <br /> cx <br />' LU d State <br /> Z <br /> LU <br /> U EPA/Other <br /> U <br /> ua <br /> ! Additional Descriptions for Materials Listed Above K Handling Codes for Wastes Listed Above <br /> r OiLY WATER a 0.1 6 <br /> LU .} <br /> J <br /> c d <br /> a <br /> O <br /> 15 Special[Handling Instructions and Additional Information <br /> z GLOVES <br />' uJ r-MF r-&Nr.Y PHONE <br /> Uj 16 GENERATOR's CERTIFICATION I hereby declare that the contents of thisconsignment are Fully and accurately described above by proper shipping name and are classified packed <br /> Vmarked and labeled and are m all respects in proper condition for Ira nsport by highway according to applicable 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 determined to be economically <br /> practicable and that I hove 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 if I am 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 /> dX available to me and that t can afford <br /> 0 <br /> Printed/Typed Name tffJ i3�1�t1L1" /� Si nature <br /> �A�O t 9 Month Day Yeor <br /> tss PyQ <br /> B17 Transporter 1 Acknowledgement of Receipt of Materials <br /> w R Pnn`ed/Typed Name Signature Month Day Year <br /> W P 1 ) 0n r f � h P r� r •r >,. (� C3 4 <br /> U- 0 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> R Printed/Typed ed Name Year <br /> LU T YP Signature Month Day <br /> V) E <br /> a R <br /> U F 19 Discrepancy Indication Space <br /> Z A <br /> C <br /> I <br /> L <br /> I c1lity Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19 <br /> T Printed/Typed Nome Signature Month Day Year <br /> Y <br />' DO NOT WHITE BELOW THIS LINE <br /> DTSC 8022A (1/991 <br />' EPA 8700-22 Yellow GENERATOR RETAIIN 5 <br />