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�te of Colifornia—Environmental Protection Agency See instructions on back of --tge 6 Deportment of Toxic Substances Control <br /> m Approved OMB No 2050-^0039(Expires 9 30 99) Sacramento California <br /> lease pant or type Form designed for use on elite J12 gird order Information in the shaded areas <br /> 1 Generator s US EPA ID No Manifest Document No 2 Page 1 is not required by Federal law <br /> UNIFORM HAZARDOUSx of <br /> WASTE MANIFEST _ �s- t� „� y' r t� T rt <br /> A State Manifest Document Number t <br /> B,s ' <br /> 3 Generator s Nome and Mailing Address <br /> t.HAFI[ <br /> >~(J-�_;EL{L _ J�� !. ry { AVE- <br /> wr r}�' �(' t f_A 1�()3 B State Generator s ID C <br /> r—AFL LIV �4VE-- � 1l✓Cty Tt �� w S * F' <br /> -. ,�. r t s vet` <br /> A Generators Phone (,...i T,) _l �^ �-}1 s'". <br /> 6 US EPA ID Number C State transporter s IDE, yY +F <br /> ^t 5 Transporter 1 Compony Name <br /> rr D Trans�tef' Phone w7 '3��' <br /> 1""f 1.. .i'� i_ - s- l» t. C3V'�.•J I' 7 s <br /> ;t Lfi r3 .i_i�T is�i + 3iti,f_ } 1 <br /> 8 US EPA 1D Number E State Tronsporter's ID <br /> 7 Transporter 2 Company Name <br /> F TrZAs er's Phone 'r e <br /> G State Faalt}y s ID <br /> ~ <br /> 9 Designate10 US EPA ID Number <br /> d Facility Name and Site Ad��es� (A1- r r=�t,�.k_s-c- r cf p r <br /> H Facility's Phone <br /> _ 12 Containers 13 Total I Unit <br /> y 1 11 US D07 Descnptfon(including Prager Shipping Name Hazard Class and ID Number) <br /> No Type Quantity Wt/Vof I Waste Number " <br /> Stated <br /> Z a.—r HA'A-t h '_` w '4lti rr i � i_ T1 tory t EPA/Other,' <br /> « M1 4 t Y <br /> iiv' E <br /> 11_ a1F t_ � ! <br /> G 1 Y State <br /> E <br /> C14 N b EPA/Other`s` <br /> E <br /> v R State- "e cY <br /> v A <br /> 6 T EPA/Other ' <br /> co <br /> OR State „ <br /> �Ine d � <br /> EPA/Other <br /> w <br /> K Handling Codes for Wastes Listed Above <br /> 1 Additional Descriptions for Materials Listed Above b <br /> L r� <br /> OILY WATER 01 L V TANK BOT—E61 WASTE s <br /> "' PROFILE # — d <br /> r <br /> V<, <br /> O 15 Speaol Handling lnstruCI60ns and Additional Information <br /> r_� JiH; srsTZ. 17. MI . L�i�TC�i_0sSTEJ1 fr. Full", t-_ <br /> ' } i-_ _i <br /> Z ya - <br /> n� /i�i t7.-.ibi_s i t .] t{i 1_ <br /> LU <br /> w _ 3. r 'Af_t- 3 i <br /> H <br /> Q 16 GENERA aOnd labeled 'Ali- <br /> CERTIFICATION <br /> all eespectscmrprohat the per coed t,on for ts of riansport is by highway according toment ore fudy and ropplicable international and notional government egulatronsshed pocked <br /> to the <br /> ree <br /> is determined to <br /> ' f I am a large uonti generator I certify that l have a pro ram in place tr reduce the volt me end currently available to me which mof waste inimizes mi es tdhe present laand future threat bo human lieaU <br /> I 9 q y <br /> 0- practicable and that I have selected the prachcable method o treatment storage or deposal c <br /> to and the environment OR d I am a small quantity generator I have made a good fadh effort to mm maze my waste generohan and select the best waste management method that is <br /> ' ce available to me and that I con afford t <br /> 0 Signaiure� y Manth Day Year <br /> Z Pn`' d TypgName ((//j fj • r—� <br /> r i 'dd t 1 r f 1 <br /> 11 <br /> _I7 <br /> ' w T 17 Trans orter 1 Acknowled ement of Receipt of Materials <br /> ea <br /> V' p Signature Month Day r <br /> � p Panted/Typed Name ?? A <br /> � T <br /> U.1 9 r ��r 1"i <br /> S �ut <br /> F -t <br /> u P <br /> w 8 18 Tions crier 2 Acknowled ement of Receipt of Materials Month bay Year <br /> Signature <br /> ' O Pnnled/Typed Nome <br /> w E <br /> V) p <br /> Q 19 Discrepancy Indl[atiOn Space <br /> V <br /> Z F <br /> Lrdous matenafs covered b this manifest except as noted in Item 19 <br /> l 20 focih Owner or O erator Ce Fihcotion of recei t of bozo Signature Month Day Year <br /> T Printed/Typed Name <br /> Y <br /> DO NOT WRITE BELOW THIS LINE <br /> DTSC 6022A(4/97) Yellow GENERATOR RETAINS <br /> EPA 8700-22 <br />