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Ii Approved OMS No 2050-0039(Expires 9 30 99) See Instructions on back of pap—b Department of Toxic Substances Contrc <br /> Please print or type Form designed for use on elite(12 pitch)typew i Sacramento California <br /> ' A L UNIFORM HAZARDOUS I Generator's US EPA ID No Manifest Document No 2 Page 1 Information in the shaded areas <br /> WASTE MANIFESTof is not required by Federal law <br /> 35 �i tl � ] � <br /> 3 Generator s Name and Mailing Address A State Manifest Document Number <br /> hitt Sir ,jl :r 1s k'" 23405911 <br /> Ln B State Generator s ID <br /> 4 Generators Phone [ I I r rT 11 • It t <br /> ' lV 5 Transporter 1 Company Name 6 US EPA ID Number C to Transporter s ID(Reserved] <br /> 00 <br /> co - <br /> it /1 ), _r r 1 rF (qt `; ( ' r r b Transporl7 hone <br /> �O 1^�(. S3i'i l P <br /> 7 Transporter 2 Company Name 8 US EPA ID Number E State Transporter s ID[Reserved) <br /> ..i <br /> Q F Transporters Phone <br /> 9 iDasignatedyppa hry Na ma and Site Address 10 U5 EPA ID Number G State facility s Ib <br />�^ Q 1 11.Is.T ... <br /> Til_ill Ys, <br /> z <br /> 0 ,} <br /> ;I F U t,i t s 1,. t ��, t1 f ' , i s H Fncrbry s Phone <br /> J <br /> Y L V 11 US DOT Description(including Proper Shipping Name Hazard Class and ID Number) 12 Containers 13 Total 14 Unit <br /> Z a No Type Quantity Wt/Vol I Waste Number <br /> t Hite H11 1riY 4+ 1 i ix t State <br /> H <br /> It1 t <br /> 3 G I I { EPA/Other <br /> N N 6 <br /> 0 <br /> co E state <br /> N R <br /> R EPA/Other <br /> T c Stole <br /> m O <br /> R EPA/Other <br /> d <br /> State <br /> L <br /> EPA/Other <br /> tr t J Additional Descriptions for Materials Listed Above K Handling Codes For Wastes listed Above <br /> b <br /> Q c d <br /> 15 Special Handling Instructions and Additional Information <br /> psi 11) 11, q)"t - '14 i11.tl lf,,� 11t„tt if I oi+llH r;,r °.ar,7Et r'saf I 1{ 0 ,T"r <br /> w f <br /> 16 GENERATOR'S CERTIFICATION I hereby declare that the contents of this con sign men I are fully and accurately described above by proper shipping name and are classified packed <br /> V marked and labeled and are in all respects in proper condition for transport by highway according to app icable international and national government regulations <br /> J <br /> If I am a large quantity generator I certify that I have a program m place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> P1.1rcoble 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 quonirty generator I have mode a good Faith effort to minimize my waste generation and select the best waste management method that is <br /> O available to me and that I can afford <br /> } Panted/Typed Name ' Signature w , to Month Day Year <br /> t <br /> T 17 Trans orter 1 Acknowledgement of Receipt of Materials <br /> sst R Pnllted/Typed Name <br /> FS,,,,.natureM / � Month Day Year <br /> S l 1 ii Jf ! t.. O r e f° t ti " r s X y� �,..+ ' �Z ?yrrtr f t 1 'r f y`F, <br /> B18 Transporter 2 Acknowled ement of Receipt of Matena]s <br /> T Printed/Typed Name Signature Month Day Year <br /> sn E <br /> Q R <br /> F 19 Discrepancy Indication Space <br /> A <br /> C <br /> I <br /> L <br /> 20 FaC,lily Owner or Operator Certification of recei i of hazardous materials covered b this manifest exce t as noted in Item 19 <br /> Printed/Typed Name Signature Month Day Your <br /> ' DO NOT WRITE BELOW THIS LINE. <br /> DT5C 8022A (1/99) <br /> EPA 8700-22 Yellow GENERATOR RETAINS <br />