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arare or�auraiuru—ur,n�+uuicun, ,. .. .-�" .r nn�e O Department of Toxic Substances Control <br /> Form Approved OMB No 2050-0039lExp£res 9 30 99) �--� See Instructions on back at <br /> Please print or type Form designed for use on elite(12 pitch firer 11( Sacramento,California <br />' _71- -enerator s US EPA ID No Manifest Document No 2 Page 1 Information n the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal law <br /> WASTE MANIFEST t Ft ; k of <br /> 3 Generator s Name and Mailing AddressA State Manifest Document Number 23405915 s++. <br /> 5 <br /> l ltlil mi. t ,ikli, Al'ilt -3 <br /> B State Generator's ID <br /> in A Generator s Phone ( ] fat Is!I S £r <br />' tY ID Number C State Tionsporter s ID[Reserved[ <br /> 5 Transporter 1 Company Name 6 US EPA <br /> LO <br /> op rr ,t`. } i r a N` I l PTS "� V D Tra sp tS!s o <br /> Or7F f- fl � f "'!rJ rTi 'r /F r s ,C °4 A, f <br /> m_ 7 Transporter 2 Company Name 8 US EPA ID Number y E Stale Transporter s ID[Reserved] <br /> J F Transporter's Phone <br /> J <br /> V9 dDI[igr oted lcli:tl4tyyNarr4eiand Site Addres t ` 10 US EPA ID Number G State Fpuliiy'IP it f+ <br />' a <br /> Z Dit k t.i H Facility s Phone <br /> trNa <br /> tainers 13 Total lA Unit <br /> U11 US DOT Description(Including Proper Shipping Name Hazard Class and ID Number) Type Quantity WI/vol I Waste Number <br /> Z State <br /> l" vt Ist, ssf- c f s + J EPA/Oiher <br /> 3 G <br /> � <br /> E State co N b <br /> oo E EPA/Other <br /> R <br /> A c State <br /> ' o T <br /> � 0 EPA/Other <br /> R <br /> fie <br /> d State <br /> Z EPA/Other <br /> W <br /> V <br /> U-1 <br /> J Additional Descriptions for Materials Listed Above K Handling Codas for Wastes Listed Above <br /> Pitilt' ' I't + f '1t]` i a b <br /> LU c d <br /> oe <br /> J <br /> ' Z 15 Special Handling Instructions and Additional Information <br /> iii I9'Jj <br /> � g accuratelyshipping <br /> Q 15 marked and labeled Fand ore on a to a pet scin proper cond tat the too for trs of transport by highway occo ding toappli able international and nate nago er men!regulations packed <br /> V <br /> If I am a large quaniiry 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 /> ti practicable and that I hove selected the practicable method of treatment storage or disposal currently available to me which minimizes the present and future threat to human heallh <br /> and the environment OR if I am a small quantity generator,I hove made a good Faith effort to minimize my waste generation and select the bash waste management method ilia!u <br /> available to me and that i con afford <br /> O Printed/Typed Name 4 r Signature '1 f . T-'� <br /> onth Day Year My <br /> V <br /> 0 T 17 Trans oiler i Acknowledgement of Receipt of Materials <br /> o <br /> C7 g Mnth Do Year_, <br /> cot: a PrintTyped Name S sr� S"g a•%fir r r ✓ .7 j�+f <br /> ' LU p <br /> LL- 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> T Pnnted/Typed Name Signature <br /> Month Day Year <br /> w E <br /> ran R <br /> V19 Discrepancy indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> E20 Fault Owner or O eratar Certsficahon of receipt of hazardous materials covered by This manifest except as noted m Item 19 <br /> T Panted/Typed Name Signature Month Day Year <br /> Y <br /> ' DO NOT WRITE BELOW THIS LINE <br /> DTSC 8022A [1/991 Yellow GENERATOR RETAINS <br /> 1 EPA 8700-22 <br /> d <br />