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Stat f California—Environmental Protection Agency <br /> Form pproved OMB No.2050-0039(Expires 9-30-99) See Instructions on back of '^e 6. Department of Toxic Substances Control <br /> Plan: Drint o type. Form designed for use on elite(12-pitch)' er. Sacramento,California <br /> venerator's US EPA ID No. Manifest Document No. T- <br /> 1. 2. Pae 1 Information in the shaded areas <br /> UNIFORM HAZARDOUSr g snot required by Federal law. <br /> WASTE MANIFEST 't, 7 '7 7 �D r ' —"f ]. of 7 <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> %,"ki Wrist'baa of-•Mry <br /> 24 10LI 8 98 <br /> slackAu", CA- sng206 B. State Generator's ID <br /> 4r <br /> n A. Generator's Phone ((;tlt i�k6.Kf.•ILKi 0 <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved] <br /> LO <br /> ao a tears.: I ?"i`r:J+iii Ei `:f '. . •..4 :d31s us: d ` <br /> p D. Transporter's Phone <br /> OF 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID(Reserved.] <br /> s � <br /> F. Transporter's Phone <br /> Q <br /> V 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> U-nw orment'i�� nrw icat= .. VI d <br /> M"?Cl4 'r ?; ,� H. Facility's Phone <br /> �::.; ram ,ar.;a. CA�=�vs:e : L: f b. 0101 V 4 :r .i £i 5171 X4,0141°��'�14;4 <br /> Q2. Containers 13. Total 14. Unit <br /> a V 11. US DOT Description(including Proper Shipping Name,Hazard ClClass,and ID Number) No. Type Quantity Wt/Vol I. Waste Number <br /> Z a. State a�y+ <br /> H '4.xdee i'agwatvaa substances, ilrg*jv-4e N'i.f 1.+:Y..wit ,_ fJ 1'.4 r7 <br /> 3 G G? :$1t? °. t w7`Ilt, p��.'F, PrY�fat�°9`l L19d*X?9Rl s.'1fr4: C71 T ; thy 1 EPA/Other <br /> Li M1"GI.1 fh. <br /> .J <br /> O N b• State <br /> 00 <br /> oo E <br /> EPA/Other <br /> In A r t' <br /> o T ` stare <br /> a80 O <br /> R EPA/Other <br /> w d. State <br /> Z 1' <br /> w <br /> ..V EPA/Other <br /> LU <br /> J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> a. Z1 b. <br /> t.-'. r <br /> C. d. <br /> J <br /> Q <br /> Z 15. Special Handling Instructions and Additional Information <br /> O <br /> LU RKW ir, <br /> t- <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 /> Q marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> V <br /> J <br /> —+ 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 economical)y <br /> CL practicable and that I have selected the racticable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> rn <br /> and the environment;OR,if I am a sma I quantity generator,I have made a good Faith effort to minimize my waste generation and select the best waste management method that is <br /> 0 available to me and that I can afford. <br /> 0 ss. <br /> Si nature Month Da <br /> } Printed/Typed Name � 9 �/ �� y,., Year <br /> LU 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> � T R <br /> LU p Printed/Typed,Nama Signature Month Day Year <br /> P <br /> W0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> 0 T Printed/Typed Name Signature Month Day Year <br /> w E <br /> V) R <br /> Q <br /> () 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner 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 /> DISC 0 (1/99) <br /> EPA 87700-0-22 Yellow: GENERATOR RETAINS <br />