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State of California-Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back of E 6. Department of Toxic Substances Control <br /> kflease pcinf or type. Form designed for use on elite(12-pitch)typewriter. Socramonto,California <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal law. <br /> `WASTE MANIFEST 1 , , of <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number 21854291 <br /> �,{ R Lt+s w �q <br /> D.-S.S. Cto9.PA]�Y 'Rs>..itr ii{r�'i 4 .ii <br /> O n•, r;srta• 95206 <br /> B. State-Generator's ID <br /> �, i:C K.C.�1, CA .2 ,. <br /> LO 4. Generator's Phone(,�nq ) yr`1f�_OS{)it �-..;a J , t ... \.•,_ _. ._yt4t_:.,._ <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. StateTransporter's ID[Reserved.] <br /> LO <br /> C>o D. Transporter's Phone t <br /> O ?A,11t) ,"V.i jit�]1E�V�i eb�.i,� �1'�iS�YTr».7 t ,) ) _ -}— 747 <br /> as 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transportter's ID[Reserved.] <br /> F: Transporter's Phone- <br /> �a <br /> `'U 9. Designated�F7acillii'ty!Name and Site Address 10. US EPA ID Number G. Sta Facili <br /> `�/Q .'_1!r1`7TI ::t�'i..i. � z ��; - t <br /> rkr Z 26th STR.!=L H. Faci i i Phone <br /> J1 VERNON, CA 91..1023 � 333 d�R--5G.5€i <br /> �� 12. Containers 13. Total 14. Unit <br /> U 11. US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number) No. Type Quantity Wt/vol I. Waste Number <br /> Y Z a State <br /> _ N''0'N--R%C,,'P-A. HAZARDOUS .4AS TV SO111D � <br /> j G FRG i. 100 #17: 1 .J }..� ` EPA/Other + <br /> > <br /> E state <br /> O N 6'N'0?4--RCRA. R ZARr'OUJ i ,SAS'.E SOL-111 ; <br /> cu E ) ZRG '00 0171 > EPA/Other <br /> CV <br /> A c State <br /> o T <br /> m O EPA/Other <br /> R <br /> ad d. State <br /> LIJt- <br /> Z <br /> w EPA/Other <br /> U <br /> LU <br /> Z J. Additional Descriptions For Materials Listed Above K. Handling Codes for Wastes List Above <br /> , a 6. <br /> LU <br /> O15. Special Handling Instructions and Additional Information <br /> f= rir'�.Pyi.°-.%sc `I:t? J3F :f'FAXMdie�r' INE+D AND USF. PPE,. <br /> Z 244!: k�M'ERGENC:.' C("kA,'�'AC.Y3>�- 916.-3;1,--5747 <br /> Z <br /> W <br /> H <br /> is consignmentare accurately 16. GENERATOR this fully and described above by proper shipping name and are classified,packed, <br /> 'S CERTIFICATION: I hereby declare that the contents oU marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> ! If I am a large quantify generator,I certify that I have a progrom in place to reduce the volume and toxicity of waste generated to the degree I hove determined to be economically <br /> G practicable and that I have selected the practicable method of treatment,storage,or dispwat Currently available to me which minimizes the present and Future threat to human health <br /> N 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 /> OPrinted/Typed Name Signature ' Month Day Year <br /> U IY+ <br /> Z <br /> w T 17. Transporter 1 Acknowled emenI of Receipt of Materials <br /> 0pnature g Month Day Year <br /> w A Printed/Typed No, <br /> ! Signature <br /> U 0 18. Trans orter 2 Acknowledgement of Receipt of Materials <br /> RYear <br /> T Printed/Typed Name Signature Month Day <br /> LU E <br /> N R <br /> U19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> I 20, Facility/Own6r or operator Certification of receipt of hazardous materials covered b 44 maniFes exce t as n tediri"TFem 19. <br /> l ' Mopth --,Dat•^-•-,r.Year <br /> T Printed/Ty ejN ma Signature <br /> g 1 { ) / f i <br /> Y <br /> DO NOT WRITE BELOW THIS-1 NE. <br /> DTSC 8022A (1/99) Green: TRANSPORTER RETAINS <br /> EPA 8700-22 <br />