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J p of Galliif9Ey)�l�i�a���Environmental Protpetion Agency <br /> FormAgpsa4e{.Wdp No.2050-0039[Expires 9-30.99)- See Instructions on batt( OE F 6. Department of Toxic Substances Control <br /> PleoseprintaWype. Fasm designed for we on-elile IF2-pitch)y w"It, 1.0111110 Sacramento,California <br /> 1. Generator's US EPA ID No. Manifest Document Noe; 2. Page 1 In Formation in the shaded.,.as <br /> UNIFORM HAZARDOUS is net required by Federal few <br /> WASTE MANIFEST _ 4{ ( -'t <br /> 3. Generator' ame and Mailing dress 'S'ote M m <br /> if.0 Dorueut Num993131 <br /> her i� <br /> � 47c; _ <br /> O n N��' r B SaeG forslD <br /> A. Ganemtor's Phone <br /> tV <br /> S. Tonspo,Mr I Company Name - S EPA ID Number State T a sp to JD IR erred j <br /> 0 0 O7 1 t ( -- <br /> O / '7' D u'rp ts <br /> aD 7. Tredsporrer 2 L M.pcory Name 8.US EPA ID Number F note r ro ter s h IRe ;.ved 7 <br /> .yam - :jhspte•,phone -- - — <br /> V V <br /> rtkyp <br /> Foci i�r�+ame and Sib Address 10. US EPA ID Number a Fac ty a I�O A�.Msl.n r <br /> _ s r r <br /> '1'� - 14. Containers 13. T I U. Uni4. <br /> M V 11 US,DOT Description lleduding Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity WtfVd <br /> �Z a.NUN t GZur ULS //t/l!) tYjr+'a'� y <br /> 3 G USF�PUi c.,.4 N/a I�r It ( C <br /> r E b. e <br /> o N <br /> W E <br /> N R <br /> o T V <br /> A CHOP �Nc�osu2E �3 e <br /> R _ <br /> K StaYo - i-.l <br /> w d- <br /> r <br /> Z <br /> V <br /> w ,r <br /> -.•'6n'al De'sc t tions Noknal ,1{ � <br /> .r <br /> O dt-�' J2j ' N# <br /> f Y <br /> D. <br /> djs <br /> -.f <br /> Z 15./5,�,�.� IH�t'aBn Iy hon Adaigonal rormation <br /> TJ`�f' a✓' k�4�Aa7�rnsa ` pr�tc¢. t <br /> a F I <br /> Z �.!♦11r-k� �i�grr.ldr t;Wl Hbb-Ss�J�Gf <br /> w <br /> �+lhr# Fvulr' 7 57-7 <br /> I6. GENERATOR'S CERTIFICATIO I hereby declare that the consents of this consignment are fully and accurately described above by proper shipping name and ore classified,packed, <br /> Vmarked ,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and nationol government regulations. <br /> If I am a large quanliy 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 economicalH <br /> o- practicable and that I hhave selected the practicable method of Irealment,storage,or disposal currently available to me which minimizes the present and future threat to human heals <br /> h and the environment;OR,if I am a small quantity generator,I have mode o good faith effort to minimize my waste generation and select the best waste management method that is <br /> ne available to me and;hot 1Co.afford. <br /> OPrinted/Typed Na a signature )month Dvy Year <br /> w T 17. Trnnz rtar I Acknowled ement of Recei 1 of Materials ✓ <br /> RA Printed/Typed Name Signature Month Day Year <br /> w 1 s y <br /> w � e P� T <br /> P <br /> U- 0 18. Transporter 2 Acknowledgement at Recei t of Materials <br /> O I Printed/Typed Nome Signature Month Day Year <br /> w E <br /> Q R <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> — A <br /> C <br /> 20. Facili Qwner or O erotur Certification of---*21 of hozardoas materials covered b this manikst except m noted in it..19. <br /> MonthDay year <br /> T Printed/Ty Name <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> 1 99 (Generators who submit hazardous waste for transport out-of-state, <br /> DTSC 8021A <br /> ( / I produce completed copy of this copy and send to DTSC within 30 days.) <br /> EPA 8700-22 <br />