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Sh a of[ajifornip--Environmental Protection Agengr t <br /> Form Approved OMB No, 2059-0039 IExpires 9-30.991 See Instructions on �OCIC Ofd f], <br /> Please print or type. farm designed for use on elide 11 2-pitch) -.rifer. "````��r��� 0eportmenr of Toxic Substances Cant:c <br /> tyF Sacramento,California <br /> UNIFORM HAZARDOUS- 1, Generator's US.EPA ID No. Manifest Document No. 2. Page T,'n�nw <br /> rmation in rhe shaded areas "- <br /> WASTE.MANIFEST % ;} t7 I 1 t fi ') [{ �; g [} " 1 3 1 of= required by Federal law. <br /> 3. Generator's Name and Mailing Address A.;StahrManifatfJocvmedFNumbec''=?=r_:cam >: ' ""' <br /> .l]iCr iriC ' i< `� <br /> � BOX 3048 . C" �;21 Z` <br /> & State•Generatce [D <br /> \ e. Generators Phone C <br /> :v 5. 7ran3parter i Comaony Name b. US EPA ID Number -C��Slotcrrompertersla <br /> n , Phone-iil, CC ran n (! 14 (? f3 15 f-S _ <br /> 1 <br /> 7- Transporter 2 Comaony Name 8. US EPA ID Number l;State Transparte,rlF3'[Aeserverf f- t <br /> a i 1 1 1 F Tr�ttsparr�rrs Ffeotte ;a , n k <br /> F. <br /> K <br /> 9, Designated Facility Name and Site Address i0. US EPA ID Number G.State Facility s <br /> Q �i�� L�t;j1'Zk.:i'F!jr�'t1TG? riJ l . <br /> j _515C0L7_H t-:'7lR 0A TES T 'SA(-ii v_T-fY!'� nA ��C,�' fi FaalsysPFians <br /> 7— <br /> JC�AJDJO 44003 , IC9.16Y''3��-5147..: <br /> 11, US OCT Description Iinclu'ding Proper Shipping Npme,Hazard Class.and ID Number) 12, Contowers 13. Total IA. Unit <br /> No- Type Ouanriy Wt/Vol -Ir.VYastes Number <br /> a 'rO"F—?CRA iAA2,DOtiS ;vAS rE LIQUID state-'`"' - <br /> 223 <br /> G 1e7atar/,-Z±rSaC_-) _1AIEERG96,'1.71 <br /> e <br /> N b' Stare - <br /> Z R EPA/Other <br /> T A 1 <br /> T <br /> -state.., <br /> a O <br /> R I I EPA/atlsa+�-: - <br /> d. I <br /> � 1 EPA/atfter ° 1 <br /> 1 Addi6onal0escreptor_wfarMoiencfsl.sste�.46av�- t`r -.yam i�'w.. nkt.`- SIC:Handfeng,CodesFarWasse:tissed-Above: : <br /> 'TS <br /> J 4�� r � - 'F" ,t <br /> �>} f- 1. Ks-_. .if�., ,•, <br /> ✓- -Fye ,. ]r ti a ^Y },.hr; _ _' 4W <br /> 15. Special Handling Instructions and Additional InFormation <br /> T � <br /> i HA.YD ERS 3E 1,0 FOUR OSPA/SARA IRAIKED 3 ito; 2650 I:ammis Ra« <br /> A%T USE Ni05� ATIPRC�I-:D pPn Szack}a CA. 9521_3 <br /> -• <br /> E CENCY CONTACT: (916) 371-5747 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the can rents of this consignment are fully ono accurately described above by proper shipping name and are clossi{ied.packed, <br /> 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 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 /> practicabie and that I have selected the practicable method a}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 quantiy generator,1 have made a good faith efforiio minimize my waste generation and select the best waste management method that is <br /> available to me and that 1 can afford. / l' <br /> Printed/lryppd Nome f-f i Signature Month , Days Year <br /> If f 1 <br /> 17. Trans otter 1 Acknowledgement of Receipt of Materials - <br /> R <br /> j A Printed/Typed Nasse Signature c/ �� Month Da Year <br /> It il O � S <br /> P <br /> a 18. Transporter 2 Acknowled ement of ReceiDt of Materials t <br /> 7 T Printed/Typed Name Signature Month Day Year <br /> i R I <br /> 1 <br /> F 19. Discrepancy indication Space <br /> A ` <br /> C R <br /> 1 20, Facili Owner or Ooerotor'Ceriification of recei r 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 /> )TSC 8022A (1/99) Bluec GENERATOR SENDS THIS COPY TO OTSC WITHIN 30 DAYS. <br /> PA 8700--22 To: F.O. Sox A00, Sacramento, CA 95812-0400 <br />