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State of California—Environmental Protection Agencyl'4 <br /> Form Approvsd OMB No.2050-0039(Expires 9-30-99) See Instructions on back O •ge 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12-pitch ✓rifer. Sacramento,California <br /> i. venerator's U$EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal law. <br /> WASTE MANIFEST s'; {; ?) f?a ! "* :: .t, ? of <br /> 3. Generator's Name and Mailing Address — A. State Manifest Document Number <br /> 4 181755 <br /> B. State Generator's ID <br /> LO <br /> A. Generator's Phone <br /> N <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.) <br /> LO <br /> aD <br /> " �� f% ( !; rT {� rE r r. D. Transporter's Phone g0 •70-20S <br /> r0F { (¢ <br /> O <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.) <br /> L-'Q F. Transporter's Phone <br /> �...0 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> ' z " ' H. Facility's Phone <br /> �., i 1, 4 r� tit 'Y ^ nS�g y432-6446 <br /> qzwr Q 12. Containers 13. Total 14. Unit <br /> U 11. US DOT Description)including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity <br /> /! Wt/Vol I. Waste Number <br /> Z a :J i '0 0 State 1 <br /> ~ '' t-•^r y'r° � - EPA/Other <br /> o N b P:"t '� j':.,, ! '(.C _ j (J State ! <br /> (33 <br /> V R .�t tt jtl a.J IV, 1 k•t 1 . :J, EPA/Other <br /> i)if,t1 <br /> A c i5f, r .1 'U 1 State in',w <br /> RZ. EPA/Other "ri+t0d <br /> LU d. State <br /> H <br /> Z <br /> w <br /> U EPA/Other <br /> w <br /> N J.{ed qno!Des nphogFor Materials Listed Above. K. Handling Codes for Wastes Listed Above <br /> Z 7 1 1 1 ! iRF <br /> Ob. <br /> V) <br /> f ,•;i# +ri4r'' Cf.n,'!f'-r.ft7 -:'�js r ',S''it< .d . <br /> C. d. <br /> J <br /> Q <br /> Z 15. Special Handling Instructions and Additional Information <br /> Ir <br /> is,,$ <br /> �` �4�::��,.b4°'tT C.. ! .3 .[ a Y�i._,e �Rt'''�' ,�i C�;� ,3,•��^el� <br /> Uj <br /> t— <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,packed, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> —J+ If I am a large quantiy 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 have 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 /> available to me and that I can afford. <br /> O <br /> ). Printed/Typed Name Signature +` -^, / ✓T Ly' Month Day, Year <br /> Z f.'1� ✓4. Y�..�� 7...n�ir �'{ /� ._.. !✓' /r•„- �ff�/ w.i"'�•.. x r... 1 <br /> T 17. Tr ns orter 1 Acknowled ethent of Receipt of Materials <br /> R <br /> w p Printec)%Typeg;Name $ignofur ,•-� •''""• „41on �-S Day' -Year., <br /> LU P ! ? r <br /> rr_ 0 18. tans orter 2 Acknowledgement of Receipt of Materials <br /> R <br /> T Printed/Typed Name ^' Signature Month Day Year <br /> LU E <br /> V) R <br /> Q <br /> () 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <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 Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A )1/99) <br /> Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />