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State of Califomia--Environmental Protection Agency - <br /> Form Approved OMB No 2050-039{Expires 9 3D-96) See Instructions on back of 1ge 6 Deportmem of Toxic Substances Control <br /> Please print or type Form designed for use on elite(12-pitch wrier I Sacramento California <br /> UNIFORM HAZARDOUS i "e^eratoi s US EPA ID No Manifest Document No 2 Page 1 Information in the shaded areas <br /> i 1 i) i f r `E3 %` I f £ ;y d L is not required by Federal law <br /> WASTE MANIFEST t of <br /> G or s N m h Address A,State Manifest Document Number <br /> C _j PG `° `?a "°r,'� q ` <br /> in lttrs N. El1F'AiJCJ ST. S{+OI �;TDts« CA :_f�� " tit 9641,.2 6 ' <br /> _ S State Generator's ID ` <br /> V1 4 Generator's Phone <br /> d 5 Frans iter 1 Corn ony Nome ¢ Ll$ A D Number 1 _� _ � C C State Transporter's IDS t- ° y <br /> � IV-I E (�I_ ' III 1_ r;L _ 1 J ' D Transporter's Phoria (2095,667-6692" �x <br /> Jl <br /> J 7 Transporter 2 Company Name 8 US EPA ID Number E State Transpoderrs ID <br /> a <br /> u <br /> F Transporters Phone <br /> Q G State FoalAy's ID r <br /> Z �9 Designqied_FaiulityTJJamq�nd Sits{R�drcss l0 US EPA ID Number <br /> x <br /> I� p -,Z:,l HOPTH Ht Ie , _',:, y <br /> LL H Focildy's Phone <br /> [ : r CEI<S[�Il. i.Ff � r <br /> a ' <br /> U <br /> 11 US DOT Description(including Proper Shipping Name,Hazard Class and ID Number 12 Containers 13 Total 14 Unrt <br /> Z P { g Pe PP g � No Type Quantity Wt/Vol 1 Waste Number <br /> f,trl24 -F I--P"s 1 1,PLjii J9 114AS Stafe <br /> EPA/Other <br /> E <br /> N b Stale w <br /> N R EPA/Other <br /> A <br /> Stara" <br /> T c <br /> O EPA�Offser' <br />' L R <br /> IW- d State <br /> Z <br /> W <br /> u EPA/O*,!*" <br /> J Additional Descriptions for Materials Listed Above _ Handling Codes for Wastes Listed Above <br /> vitt WATER FROM PURGE: weds a b <br /> W <br /> J i <br /> Z <br /> Q 15 Special Handling Instructions and Additional Information <br /> P c-PF ROP'IIATE I--'POTErTIVE 1;I_OTH11111 ?C' 1 ��ITt 11;�414'l =;�J� I F FJ A Ir <br />' z iiE11PPGFEN1=Y 1:0 I FtCT� ' .�i--t'3l[>E-'ME-, 9;. Mt,� t1. + �ttIT c f f E� <br /> YE E« I1. L. <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 <br /> J <br /> Upacked marked and labeled and are m all respells in proper condition for transport by highway according to applicable international and national government regulations <br /> If I am a large quantity generator i certrfy 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 <br /> economically practicable and that 1 have selected the practicable method of treatment storage or disposal currently available to me which minimizes the present and future <br /> t�lJ 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 /> Signature Mon1h Day Year <br /> 0 rpril <br /> nted T d Nome{ r' 9 <br /> u <br /> ' u t 1� 1, i�q,,^ trA_ fit-t /: �I �"1 -f t� r <br /> Z T 17 Transporter 1 Acknowledgement of Receipt of Materials <br /> W A <br /> otgh e <br /> A Penrod/Typed Name Signature �" `f ayYear.� <br /> Lu s I- E N F I..I I=T T `n / y� ✓,f I 7 �/ �' y <br /> w0 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> ,� T Printed/Typed Name Signature Month Day Year <br /> O <br /> A <br /> N19 Discrepancy Indication Space <br /> a F <br />' Z A <br /> Z C <br /> I <br /> I 20 Facdi Owner or Operator Certification of rOcei of hazardous materials covered by this manifest exce las noted in Item 19 <br /> 1p L <br /> T Printed/Typed flame Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE <br />' DTSC 80222A (1/95) Yellow GENERATOR RETAINS <br /> EPA 8700-22 <br />