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State of Cohfornia—Environmental Protection Agency <br /> Form Approved OMR No 2050-0039(Expires 9 30 99) See IRSf�UCfIO[15 011 back C .ge 6 Deportment of Toxic Substances Control hx <br /> Please pant or type Form designed for use on elite f 12 pitch)typewriter Sacramento California <br /> UNIFORM HAZARDOUS I Generator s US EPA ID No Momfest Document No 2 Page 1 Informotion in the shoded areas <br /> is not required by Federal law <br /> WASTE MANIFEST f t l r of <br /> 1 <br /> tF�U�S <br /> enerator s Name and Maden Address A State Manifest Document Number _ <br /> 9 �+ A <br /> �EI�L_ CHAFIN J6�J` 1621 <br /> nl t - s='-r ,^ 8 Slate Generalor s IDt'} t�. I_ri'"L_l Er11 J I�.EY. . ;� r,l_t fLIT1. I-A �J_. �� enerator s Phone (�ransporter 1 Company Name 6 US EPA ID Number C Slate Transporter s ID <br /> Ln <br /> DO <br /> NOP 1_LiL OIL_ I_ 1 D � 9- 4 1-7 ..-f 55 o Transporlei s Phone - YT F r <br /> e0 7 Transporter 2 Company Name B US EPA ID Number E Stale Transporter s ID <br /> F Transporter is Phone T <br /> Q r <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number G State Facility is ID s s < <br /> Y 31 414/- <br /> "V-opr 'rt �i rt1 r{,T1 r'I" - H FanttysD � J " / U0" /R <br /> I_ T 111 17 (�t i ` .�c'( t I 1'fi _� s� i '-sr _ '} , <br /> 12 Containers 13 Total 14 Unit fv <br /> I 1 US DOT Description(endudmm <br /> g Proper Sh�ppg Nome Hazard Class and ID Number) No Type Quantity Wt/Vol I Waste Number <br /> a State <br /> hjc[ hl F i (r t c j II ,c l,l, c, rF r C11 i s 3vA . r <br /> 223 <br /> G 1 fy�t-F st r -r In EPA/Other <br /> CVC] N b Slate a '� <br /> co E <br /> EPA/Other , s <br /> v A I <br /> c Stare <br /> o T <br /> G EPA/Other s' <br /> R - p <br /> wd State <br /> � T <br /> L <br /> W <br /> U EPA/Other,� <br /> W <br /> J Additional Descriptions far Materials Listed Above K Handling Codes for Wastes Listed Above <br /> rr, I=f f E WATER <br /> W r <br /> c d <br /> 0JQ <br /> Z 15 Special Handling Instructions and Addet.onal Information r <br /> Q fFj-- f71'=F7r FCj- ElT 1 'sG I-' fIT1 T1,11i <br /> 'i 1� jfjE ..J f 11 / <br /> Z riPrcP ENI, { i fit;4TA T. , ._ -�� s { � C�`/ J �s/�' �� �-5� � '��r- MT DT_AIEJI-0 s <br /> r-f-- E F 1. i*' , � 5Tnf-f Tntl, tµ1 ' <br /> .:j 16 GENERATOR S CERTIFICATION I hereby declare that the contents of this corsiynment are fully and accurately descnbed above by proper shipping name and are classified pocked <br /> Vmarked and labeled and are in alt respects m proper condition for transport by highway according to applicable mternohonal and national government regulottons r <br /> J <br /> _ If I om o large quantity generator I certify that I have a program m place to reduce the volume and toxicity of waste generated to the degree I hove determined to be economically t <br /> CL prochcable and that I have selected the rachcable method of treatment storage or d�sposol currently available to me which minimizes the present and future threat to human health <br /> and the environment OR .f i am p small quantity generator I have made o good forth effort to minimize my waste generation and select the best waste management method that is <br /> ac ovadable to me and that I can afford <br /> ' O Pnn}e (Tyspgduome f r / Signature \' �� nth Day/ ear 7 <br /> lE ff f +�f. G( l�f ,rj (��I ff t / �7? <br /> w T <br /> � 17 Transporter l Acknowledgement of Receipt of Materials i <br /> LU R <br /> u.l A Printed/Typed Nome Signature �- � Month Day Year <br /> Lu 17 1 �j17 <br /> U- p 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> 0 1 Printed/Typed Name Signature Month Day Year I <br /> w E <br /> ' R <br /> (a,J 19 Discrepancy Indication Spate <br /> Z F <br /> — A <br /> C <br /> f <br /> L <br /> f 20 Facility Owner or Operator Cerhfecahon of receipt of hazardous materials covered b this manifest except as Holed in Hem 19 <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE <br /> DISC 8022A (4/97) Yellow GENERATOR RETAINS <br /> EPA 8700-22 <br />