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ySsatq of Califomia—Environmental Protection Agency <br />r of <br />OMB No. 2050-0039 (Expires 9-30-96) See Instructions on back f Ige 6. <br />please print or type. Form designed for use on elite (72pitch) ypewrhw. <br />UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. <br />WASTE MANIFEST (� 5 < <br />3. Generator's Name and Mailing Address A" <br />S7aCk�oy Vd1F1tuSC,NOOL ,. <br />19 4 q ►..► . Ea- ?I U AL��� C -4 � 5� 05 �5 <br />In4. Generators Phone (24q 953 —4c)6 <br />6 5. Transporter I Company Name 6. US EPA ID Number t= <br />J ! r <br />J 7. Transporter 2 Company Name `8. US EPA ID Number 30 <br />Q <br />�U <br />Q <br />CY <br />O <br />.0 - <br />+� Q <br />U <br />Z <br />2 <br />3 G <br />C'' E <br />O <br />wN <br />00 E <br />v <br />C-' R <br />v <br />o A <br />O T <br />O <br />R <br />LU I <br />t - <br />Z <br />w <br />V <br />w <br />Z <br />LU <br />O <br />a <br />Z <br />O <br />Z <br />0-1 0- <br />CY <br />I <br />OI <br />r <br />V <br />Z T <br />w R <br />TD A <br />N <br />Cy - <br />S <br />P <br />w 0 <br />R <br />LL. T <br />O E <br />R <br />LU <br />u7 <br />QFA U <br />►AC <br />L <br />IT <br />Y <br />Department of Toxic Substances Contro <br />Sacramento, California <br />2. Page 1 Information in the shaded areas <br />Page; <br />is not required by Federal law. <br />of <br />t <br />F:Trcnsi6ortar%Xc,4 <br />9. De}�'gnatecd{ Facil�'rttyy N,ggme and Site Address 10. US EPA ID Number G State Facility 3-'fD ' <br />ter 1CK8C�L1 . <br />127C <br />255 Purr. BlI,i - H FaahtysPhone' <br />Ridulxmd,CA, 9480)1 <br />12. Containers 13. Total 14. Unit <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) No. T Quantity Wt/Vol 1. WaHe'Number . <br />0tK-)N-RCP? A Hazy XV -A -LS Waste SCI) -id stats 12 <br />Waste E7mj:7EV 3toL+��f Ti!. k.. ^� � v� T � o� C F EP;� <br />State <br />b." <br />C. <br />d. <br />EPA/Other <br />state <br />EPA/Other <br />State .. <br />(EPA/Other <br />J. Additional DescrYr��ft�a�ns for Materials Listed Above K. Handling Codes for Wastes Listed Above <br />Storage Tann iz.)#..� .r19 s1 ,`�. b. <br />_.T�41kio + kla I✓aefH. 'Inert ed 04i th 15 <br />I >L 'v Ice PnC. 10 71 u� %ac. it -v: t C. d. <br />15. Special Handling Instructions and Additional Information <br />FEE O{ 3:cj` fI .>Tia s, u_k7ez %--f ].gait irH't. AIv;av,- •vcclr harrlclt:.3c.vien (•�F.)Lkin<:f arcAinl <br />i.(-'-'?X1CY_.� lC�i't.�'. C...7 3.'._C.f'.�v.i� t�11J T''rI:-i– 'llfr.- <br />c H 4 A? Z- eusk/z � Cy -<,- C 69 f 0,1-1 <br />16. 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 />packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br />7. <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 />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 />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 />waste management method that is available to me and that I can afford. <br />eta/Typed Namet1 signatureMonth Day` . Year <br />Tr orter 1 Acknowledgement of Receipt of Materials <br />ed/ ped Name .1% Signotdre Month DayYear <br />18. Transporter 2 Acknowledgement of Receipt of Materials ` <br />Printed/Typed Name signature Month 1 Day Year <br />I <br />19. Discrepancy Indication Space <br />20. Facility Owner or Operator Certification of recei t of hazardous materials covered by this manifest except as noted in Item 19. <br />Printed/Typed Name I Signature Month Day Year <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/95) Yellow: GENERATOR P,ET-JN: <br />EPA 8700-22 <br />