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State or California--Environmental Protection Agency <br /> Form Approved OMB No 2054-0039(Exp+res 9 30 99f See Instructions on back of page 6 Department of Toxic Substances Controf <br />'I Please print or type form designed For use on elhre(12 p,tcA)lypewrrfer I Sacramento California <br /> 1 <br /> 1 Generator s US EPA ID No Momfest Document No 2 Page 1 In{armaiion in the shaded areas <br /> UNIFORM HAZARDOUS s not required by Federal law <br /> WASTE MANIFEST � 41t�jt t1 I� a I} r r +; ra ': afI <br /> k <br /> 3 Genera for s Name and Marling Address <br /> A Slate Man=fest Document NumberF �j ,r <br /> E :'ttlkz �'IITz}jt t 9.939453 ,, <br /> I B Slate Generator s LO <br /> _s,V'i I ACN(it 1A-ilI I ; j1 °t�_' f <br /> n 4 Generators Phone l Jyi s s ] f( + }[ 4 <br /> s i i. .,11' <br /> N 5 Transporter 1 Company Nacre 6 US EPA ID Number C State Transpo0es s ID(Reserved t <br /> oD Transporter s Phone 14 <br /> O ''t <br /> F •T r , <br /> 7 Transporter 2 Compcny Nome 8 US EPA ID Number E State Transporter s ID tl2eser" ] M <br /> J F Transporter s Phone " <br /> J <br /> Q <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number G State Foc,h'y s ID <br /> d Ott: 1:�lJ_t-f'i3 INt, ' <br /> su,j ii f 07 H Facility s Phone s <br /> r 11 <br /> 1tf V'fJs+ ii s\Jill r c �i,s Stir+1 ,i {\ �r t iro <br /> —+ 12 Containers 13 Total 14 Unit I ' 1+ <br /> V 11 US DOT Description{including Proper Shipping Nacre Hazard Class and ID Number} No Type Quantity Wt/Vol I Waste Number V ' <br /> a Stole <br /> S r of flt� s 4'_k •R i�p5i f'�S iI ii�i I'T 'i��Jx f l i !t�i�'i�.,1 - �� <br /> �1 u EP4/Other <br />'? <br /> , G <br /> • 3 <br /> b State <br /> CN �N <br /> o0o E, + EPA/Other a <br />'v R <br /> V A c State <br /> O j <br /> Q EPA/Other <br /> Stole <br /> it <br /> Z <br /> � r EPA/Other <br /> V <br /> 3 Additional Descriptions for Materials Listed Above K Handling Codes for Wastes L sled Above " <br /> s]�> irr 1`s- x ,f,o V'—r_, I a b <br /> 000- t 4�iIS tK M At 1Z <br /> rn <br /> L d <br /> C <br /> Q — <br /> Z 15 Soecral Handling Instructions and Additional Informalion <br /> O <br /> 4 • � <br /> ZLU <br /> it t'i« •\s of_>�jl < t s. . ," ti A <br /> i SS Ii . FF <br /> 16 GENERATOR S CERTIFICATION I hereby declare thar ttre contents of thr constgnmen are fully and nccvrctely de embed above by proper shil ping nrime cnd ore clossrhed packed <br /> Q marled and labeled and are m all respects in proper condition for transport by highwuy according to applicable internalionol and notiunal governmr nt regutalions <br />' If I am o large quantity generator I certify shot I have a p*ogram in place to reduce Ike volume and toxicity of waste generated to the degree I hove determined to be economically <br /> a prccticcble and thct I hove selected the racticeble method o treatment storcae or disposal currently avi% inkle to me which minimizes the presen and future threat to human health <br /> cn <br /> and Ile en%irori OR if I am a sma 3 quantity generator I ha e made c gcod fcuh effort to minimize my wase generation and select the best waste management met o tat is <br /> avoiloble to mr ord that I con o€ford <br />'O Panted/Typed Name Srgnnture Month Day Year <br /> V <br /> T 17 Transaorter 1 nci rohledgen,enl of Recei I of Mot,rrals <br /> A Printeo/T)ped Nome �w t ,I Sicurip ure 'r• �J ✓ �f_,. 1..+.r Month Day , YearLU <br /> r <br /> LU P ` <br /> 018 Trons orter 2 Aelno,vled en l of Pecei t of Materials <br /> R Printed/Typed Na1ne Signature Mpnt}, Day Year <br /> T <br /> a E <br /> un R <br /> U1 9 Discrepancy Indication 5pnce <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> f 20 Friuli Owner or O ercnor Ci,rlihcation of recer t of hazardous molerinls covered by this monied exec I as noted in Item 19 <br /> T Prmted/Typed Nome Signature Montk Day Year <br /> t Y <br /> DO"NOT WRITE BELOW THIS LINE <br /> DTSC 3022A (1/99) 1 ellow GENERHTOR RETAINS <br /> EPA 8700-22 <br />