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State of California—Environmental Protection Agency <br /> Forvv,..Approved OMB No.2050-0039(Expires 9.30-99) See Instructions on back of ''-^e b. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12•pitch)I ar. Sacramento,California <br /> UNIFORM HAZARDOUS 1. generator's US EPA ID No. Manifest Document No. 2. Page 1 In in the shaded areas <br /> �} ,7 fr't r #`' %/ i is not required by Federal law. <br /> WASTE MANIFEST C i C ✓ ] ' <br /> of <br /> 3. Generator's Name airM6 <br /> kiG ff1 '4td!`i.it,'", A. State Manifest Document Number24108777^g 7 <br /> 152 <br /> btolr4lian,CA 9 12U(i B. State Generator's ID <br /> N ,M1 IAd <br /> A. Generator's Phone (1209w <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> LO <br /> OP <br /> D. Transporter's Phone <br /> o 4_, *I t V1a � -ti bl 21 i-,j t !r <br /> * a? 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved] <br /> J F. Transporter's Phone <br /> U 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> Q ,.•Y iY" �- at iw� n. 'x IwI+R.�! <br /> PCl <br /> 101 <br /> $ !,1 <br /> a Ri 'Y�x- n. sit- itr" :`±v e;r;re•r,..�:r�e��, � }. � � � ti <br /> t '`;'2�Z X-.fin . :4 <br /> y '. H. Facility's Phone <br /> U_ w..aa.r�u u4rw umn:, a .iO vel.i t' L `Z '4 .u". U " S k7..w 01.1 Z, M.d U, t <br /> �Q r .W V 12. Containers 13. Total IA. Unit <br /> U 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/yol I. Waste Number <br /> Z a. ! State <br /> F a.�%�e�a"5''�a"ijt&me�>ii�� a�+u�zac74"sk:�.St n+a�+.�6v.•_ rd.a.i.`,.3.'�' ( _.,.� r.<: <br /> 3 Grkh+ }'ire-a }rP Qg£ !-Fult..i9i 8' i^'"�S tr9;d�s?+I' �. l63"'9:11 7 (; �,Jrr�. EPA/Other <br /> o N b' State <br /> � <br /> E <br /> V R EPA/Other <br /> A c State <br /> o T <br /> coo O <br /> R EPA/Other <br /> LU d. <br /> State <br /> VEPA/Other <br /> LU <br /> ` <br /> J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> i <br /> LU <br /> c. d. <br /> J <br /> Q <br /> Z 15. Special Handling Instructions and Additional Informations <br /> {'"'Yr:.qlp. n;s^3r..°�. �'�H;`:a ". "' �..y:. l..••11T:�".'0'CM Y +�s.ra-+tix'.r's' :✓L' !`�Lrr�.:'S•�r�, `!."!'.�v.: IQr!gT1. x+, `.l'S�•F�.''�,.' '.}�t:.. N)' ! <br /> Empreency Response 0410LA Hook *171 <br /> W <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are Fully and accurately described above by proper shipping name and are classified,packed, <br /> Vmarked,and labeled,and are in all respects in proper condition For transport by highway according to applicable international and national government regulations. <br /> J <br /> J If I am a large quantity 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 /> d practicable 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 /> V) and the environment;OR,if I am a small quantity generator,I have made a good Faith effort to minimize my waste generation and select the best waste management method that is <br /> available to me and that I can afford. <br /> OPripted/Typed Name - Si@nature Month_ Day..., Year,._. <br /> i <br /> LU T 17. Transporter 1 Acknowled ement of Receipt of Materials <br /> R <br /> LU a Printed/Typed Name Signature Month., Day,7 /Year <br /> LU _- <br /> U_ p18. Traniporter 2 Acknowledgement ement of Receipt't of Materials <br /> 0 T Printed/Typed Name Signature Month Day Year <br /> LU E <br /> N R <br /> V19. Discrepancy Indication Space <br /> F <br /> Z <br /> - A <br /> C <br /> I <br /> L <br /> I 20. FacilityOwner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />