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State of Califomlo—Environmental ProtectionAgency - •. <br /> 6.See Instructions on back of page Form, - <br /> Approved OMB No_2050-0039(Expires 90-95 � - - � g �Department of Toxic'Substances- <br /> car rhol <br /> Please print or type. Perm designed for use an Wife 02-Affch)typewriter. - - - Sacramento,Caldrm <br /> oa vz" <br /> UNIFORM F{AZARDOUS �1' <br /> Generators US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal tiff.: <br /> '71WASTE MANIFESTof <br /> `f 1A In 19 18 11, 11 16 13 41PY 1 <br /> 3. Generator's Name and Mailing Address <br /> ST'OOMM UNIFIED SCHOOL DISTRICT <br /> Q392 x AL! STOCKMN CA 9520 <br /> u7 4. nerato s one <br /> W09 <br /> .. 5. Transporter 1 Company Name 6. US EPA ID Number <br /> m <br /> RMS ENVIRONMENTAL <br /> SERVICES CAD044003556 <br /> Q <br /> 2. Transporter 2 Company Name B. US EPA ID Number <br /> U - <br /> 9. Designated facility Name and Site Address 10. US EPA ID'Number <br /> Q DEMENNO/KERDOO <br /> d' 2000 ALJkMA STREET, COMIPTON, CA 90222 <br /> a <br /> -W V 12. Container 13. Total 14. Unit <br /> Z 11, US DOT Description(including Proper Shipping Name,Hazard Class,and ID Numbed No. Type Quantity WI/Vol <br /> k' (P , f14S746` sem/. /C, 3� Wlt2.0.3, <br /> _._ <br /> Cq6nl 4Td <br /> E <br /> QD N b. <br /> 4 E <br /> ,..i a R <br /> . <br /> 00 e <br /> a� <br /> O <br /> R <br /> w <br /> Z <br /> d, <br /> LU <br /> U <br /> --w <br /> V) <br /> L <br /> J <br /> Z <br /> i 0 15. Special Handling Instructions and Additional Information <br /> P HANDLERS SE 4o HOUR OSHA/SAMA TRAINED T <br /> Z ANV uJE NIOSH APPROVED PPE. F2�r. 690*`i<Z <br /> F 24 HOUR EMERGENCY CONTACTa (916) 371-5747 <br /> 15, GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, <br /> Q pacl--d,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable internafionol and national government regulations. <br /> _ U <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 <br /> J economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> VV)) .threat to human health 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 <br /> or waste management method that is available to me and that I can afford_ <br /> P ad/Type Name Signator IL Month Day Year <br /> V <br /> w R 1ans. Trorter 1 Acknaow ement�RSipt of Materials i <br /> R Printed/Typed Name A Sig ahr, A Month Day Year <br /> w OA <br /> w 0 18. Irons orter 2 Acknowle ement of Recei t of`Wt <br /> R <br /> LL T Printed/Typed Name Si hire Month Day Year <br /> Q E <br /> R <br /> N19. Discrepancy Indication Space <br /> Q F <br /> V A <br /> Z C <br /> L <br /> _- I 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> j T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/95) Yellow: GENERATOR RETAINS <br /> j EPA 670022 <br />