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.. <br /> 14 <br /> MUM <br /> State of California—Health and Wellare Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-9 1) Depanmem of Health Selwces <br /> Please pilot's'type. (Form designed for use on e(ife(2•pdch rypewr+ler), Toarc Substance=Central Division <br /> ..acrememo,California <br /> UNIFORM HAZARDOUS GglpretAt'�ISFPA�DGYa� �/��/ Manifest 2. Paget lnfoimation in the shaded areas <br /> WASTE MANIFEST V VV SSVN-457 J Documans No. <br /> of is not required by Federal law. <br /> 3.GerygrelOs N&me�gd Majjinp•q�ryess ;, (7n0�/^�dr,49 <br /> A. State anl(est Document Number <br /> (�// 7�L53f' (�/S/ �(,/V�/SCJ �"f+/, .��7N(/ 0095 <br /> C .8eneralor's Phone( <br /> ) �.y.�} w/t� /j y��l� B• t t <br /> at <br /> h 5. Transporter t Company NameUS 10 Number <br /> ut C.Stale Transporter's ID <br /> n C� <br /> N ? L ' �j D.Traneparter's P <br /> m T.Transporter 2 Company Name B. ' US EPA FD Number E. atT <br /> e ranaporto.l 10 0 7S-0 <br /> O <br /> 0 <br /> caF. Tranapariar's phone <br /> 9. esignafetl� Name rtd"Site ;dr ` 10. US EPA 1D Number G. Sleta Facility's ID <br /> �OVO fir/ �1'••"'//JFV V O� <br /> U H.Faoility's Phone <br /> Oh rC7 a <br /> 0 t t, US DOT Description(Including Prape lipping Name,Hazard Class.and 1D Number) 12_ Containers ta. Total 14, I. <br /> �a♦ Q No. I Type Quanrily Unit Waste N0. <br /> U WI/Vol <br /> 2 stela <br /> G _ <br /> E tl 1 0 ) ) y /�N L'Ji�Y rIJ�•�.(:7^^Y I� U N. EPh/Clher <br /> E b. <br /> iv R <br /> A &late <br /> T <br /> N 0 EPArOthar <br /> C9 <br /> R C. _ <br /> O Slala . <br /> ro <br /> EPA/Other <br /> Q <br /> LU d' . <br /> Z - State <br /> W <br /> U� <br /> - w EPAlrhher <br /> Z J.Additional Descriptions for Materials Listed Above <br /> n K. Hall Codes for Wastes Listed Ahova <br /> a. - b. - <br /> 0 a- C]IL. a <br /> Z <br /> a <br /> >� t5, Special Handling Instructions and Additional Information <br /> ��� m��� s� rd ;r47'C,i <br /> f fV 7 7 Dke'4) sMe',Zr' <br /> GENERATOR'S CERTIFICATION: 1 hereby dada's Inaj tna contents of this Consignment are luny and accurately described above by proper shipping name <br /> J and are dassilied,packed.marked,and labeled.and are in all respects in proper condition for Iranspolt by highwa;ecce Mg 1 ap li able' lernalionel <br /> - - national government regufale0ns. - fq/ 9 t��_}`g_ 0147 1 <br /> - It l am a large quantity generator.I certify that I have a program.n place to reduce the volume and toxiCdy at sesta Oene sled a the degree l have determined <br /> O to beeconomically practicable and that i have selected the practicable method of tra3lmem,storage,or disposal currently available to me which minimizes the <br /> y present and future threat to human health and the environment:OR,it I am a small quantity generator.1 have made a good faith effort to minimize my waste <br /> Zgeneration and select the peat waste management method that is available to me and that I Ca atloid. - - <br /> Pri dl Typed ams - Si nature <br /> g Month Day Year <br /> x ti <br /> r r! /I o <br /> w T i. i'ansporler 1 Acknowledgemer of Receipt of Materials r - <br /> R <br /> A Prinretl/Typed Name <br /> NSignature <br /> Day.---Year -- ------ -------- - ---._. <br /> --y p f a.'.Transporter2 Acknawledpament o!Receipt a1 Maturia la in <br /> (J <br /> C p ;rinled/Typed Nama - - - <br /> U .E. __ .. _ . . Signature - Al Day Year <br /> 2 R - - - - - - <br /> 19, Oiscrepancylndicaiian Space - - - <br /> - A <br /> C. <br /> - - . <br /> t 20. Fel Owner Or Operator Certification of receipt of haeardous materials covered by this manifest except as noted in Item 19. - <br /> T <br /> Y PrintedlTyped Name <br /> - - Signature - - Al Day Year. I - - <br /> DHS 8022 A(t ra8) <br /> EPA 8700-22 .. - Da Not Write Below This Una - - <br /> (Rev.9.88)Previous editions are obsolete... - - .�.r1: Ciii�ti•ESATQk $i:Nfi�_;i,„ r.�i, r,r ,r, - <br /> ®� <br />