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3 Q <br /> '.a-Enmonmernal Protection Agency( 4/ � / <br /> �. .ed OMB No.2050-0039(Expires 9-30-94) V See Instructions On back 6�19e 6. (i Department of Toxic Substances Control <br /> n or ype. Form designed far use on elate(1}^7p'tirch)ypewdier. ! Sacramento,Cal forma <br /> UNIFORMHAZARDOUS; 1• Generator's.US EPA ID No. Manifest Document No. 2. Page 1 -Information in the shaded areas <br /> ` is nal required by Federal law. <br /> WASTE MANIFEST O or/ / .3 / / 1!f <br /> 3. Generabr s No.a Ma:hng Addraggg - S��o.Pe � ' �i1atl�fCefl Nu +y s..Y <br /> h ' .�Sd f!E`/s•�-t'r/Il/Te' .Trc:re.7'" �', - <br /> i <br /> Pr32 , <br /> r . _.. <br /> h , Ger:erarorlsvne'rie y5r&))�;�1 in-oz) I <br /> : .. a <br /> 5. Transporter 1 Company Name :. 6. US EPA ID Number - fi.?$tatBTSonsporfeYs ID sagas �� <br /> 44/ <br /> Q. 7. Transporter 2 Company Name b <br /> : - R. US EPA ID Number ;$fat4}FaaSppAer's ID "" "ti -TT''*: <br /> ,r.4 y,Designated FZ Name and Site Address 10. US EPA ID'Number G,''%.Nta FbaRN7% ;F{ s "i <br /> a. (G/braze �ve1..Faa:.r7 i?.� �i�/ - .e + ;fit : • . <br /> Q 710Scu/�or�? !3/✓GR : m <br /> Ma yOZ3 <br /> U 12. Cont iren, 13. Total 14. Umf ¢ <br /> li Z 51 US DOT Descnptan(indudmg Proper Shipping Name,Hazard Class,and ID Number) No. Type - Quantity -Wf/Vu1 I(aWbsb.Nam4e"a„ . <br /> N� <br /> w. <br /> "N b <br /> w E . t <br /> .. Ny A <br /> "damState <br /> so "O <br /> � e <br /> w d - 's - Spi0V 4 <br /> rts, - <br /> U <br /> W <br /> .Z MaSe7fsib`:f, Ted' Nae ag <br /> y u it <br /> A' v <br /> .0 15. Special Handlin Insh 'ons sm Additional'Information ��P�-J Pits y i'ri,.. e <br /> a 1(1e� 1G�a�` <br /> z <br /> -.»z 3. <br /> J16. GENERATOR'S CERTIFICATION: I herebydeclarethat the contents of the consignment aro fully and accurately described above by proper shipping name and arc classified, <br /> packed,marked,and labeled,and are in all respedf in proper condition for transport by highway according to applicable federal,stateand international laws <br /> U . <br /> If I am a large Baan ty generator, l certify Met I how a program in place to reduce the volume and toxicity of waste generated to thedegree t 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,II am o.small quantity errermor, 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 /> Q Prngg 3ypeQ,Na /e/�Gr�.y7 .Sig e - - Month Day Year <br /> /HUK r f� e o 8,ro 9 3 <br /> Z T 17.'Transporter 1 Acknowledgement of Receipt of Materials :if <br /> 0 i Pri /Typed Name '- Signa .. - '� Month .Day Year <br /> 0 18. Transporter 2 Ac nowl.doesseii6iff Rec. if <br /> W i Printed/Typed Name Signature II Month Day Year <br /> LL e N <br /> Q <br /> 19. Discrepancy Indication Space - - <br /> Is <br /> 1 U -A - <br /> Z C <br /> k <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered b is manifest ante 1 as noted in Ite9: !I <br /> T Primed/ ped Name SignoNro I( Month Ddy Year, <br /> " � . . , . q <br /> DO NOT WRITE BELOW THIS LINE: <br /> - I <br /> Yalta.: ..TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS.. <br /> DTSC 8022A (7/92) (Generators who submit hazardous waste for imnspo t out-of-state, <br /> EPA 8700-22 - r �` 1% 'produce completed copy of this co ky and send to DTSC within 30 days.) <br />