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cvaa+- w{expiresd-ju-Vl) ToxIC$Ybatances G4ntF0I DI iG <br /> P1feasts prinf or type. (Form designed for use on Wife C',�io`��rpewriter), t� ' Sacramento,Calil <br /> JI:UNIFORM HAZARDOUS I M's US EPA to No. Manifest s /e , <br /> DoManifo No. v Information In the ahaded areas <br /> WASTE MANIFEST 761 is not required by Federal law. <br /> Generator's Name and Mailing AddreJsJs/ /� `- J A. State Manifest Document Number <br /> 90002782 <br /> 8. State Generator's ID <br /> 4 Generator's Phone ) <br /> -ClLn 5..Transporter 1 Company ams 8. US EPA ID uatbe C. ate T <br /> CM1 0- Transporter's Phone <br /> G <br /> . 1 <br /> _.� <br /> Go � a 5 P ID u ber E. State Transponees to <br /> O E' <br /> m !; F. Tranaponer's Phone <br /> 9.;'.Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> U Wkjs E.141"M:t'a4Ti'L SUVICES H. F citity'a hone 1 51 &1 1-11 ) <br /> N _a 1615 SGUTH RIVER MAD, 'JEST SACRA'����'' � � � *� � <br /> r� zIs _ -71 <br /> w4!5 2. on <br /> tj <br /> Ctainers is otal 14. 1. <br /> Oa 1 f i US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) Quantity Unit Waste No. <br /> a No. Type Wt/Vol <br /> azV ai <br /> State <br /> Gl!,w�s .�f ,�a�,�,6� <br />© � N ,f' EPA! <br /> A b•'`; r State <br /> A <br /> T EPA/Other <br /> O <br /> rq <br /> a R C. <br /> Stats <br /> EPAiOther. <br /> LLJ d I'. state <br /> Z <br /> U li; EPA10ther <br /> LU <br /> II <br /> Z J. Additional Dewiptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> 0 4G a. b. <br /> cc <br /> d. <br /> 0 <br /> P 16. Special Handling instructions and Additional information <br /> Zj <br /> U <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> Jr and are Classified,packed,marked,and labeled,and are In all respects in proper condition for transport by highway eccording to applicable international and <br /> 0. ( national government regulations. <br /> If I am a large quantity generator,t certify that l have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined <br /> 0 �'to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the <br /> present and future threat to human health and the environment;CO.it I am a small quantity generator.I have made a good faith effort to minimize my waste <br /> U I generation and select the best waste management method that Is available to me and that I can afford. <br /> Z <br /> Printed/Typed Name / 4 /+` Signature Month Day Year <br /> LLJ <br /> Lu T 47. edgement of Receipt o}Materials <br /> R <br /> Z A Peihted/Typed Name <br /> N Signature Monfh Day Year <br /> ¢ <br /> LL s 'I <br /> O p 4 Ma IL le 601rc-4 <br /> W 0 18. Transooder 9 Aclihdwie!gtant of Receipt of Materials <br /> ,9 T Printed/Typed Name Signature Montt Day Year <br /> E <br /> Z }II <br /> 19. Discrepancy Indication Space <br /> F <br /> A E <br /> L f` <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covers y tl' m $t except as naM in Itepf 19. <br /> T <br /> y Printed/Typed Name Signatur r Day ar <br /> 'L POWERS (I I a ka I l <br /> DHS 8022 A(ii88) Do Not Write Below Thiskine— <br /> EPA 8700--22' <br /> (Rev.8-88)Previous editions are obsolete. <br /> Yellow:TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DA <br /> s <br /> ._.�...r--.,:.........�. ,.. .. ....rte .. ..,..��, ....,,,_._._. —� ..-..,,.._...__� <br /> 4!i <br />