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State of CnYfomie-Health and welfare Agency See Instructionson Back of Page 6 Department of Health Services <br /> Form Approyed.OMe No.20�(F0039(Expires 9-30-91 and Front of P Toxic Subatencas Control Division <br /> Sacramento,California <br /> Please print or type. Form designed for use on elite( h typewrited. <br /> UNIFORM HAZARDOUS Generator's US EPA ID No. Manifest 2. Page 1 Information in the shaded areas <br /> Document No. <br /> WASTE MANIFEST t i (J i Q of is not required by Federal law. <br /> a., <br /> Generator's Name end Mai ng Address A. State Manliest Docum t umber <br /> DDR1,,4—S ARET SITE 4-90031 <br /> >>tr CA 95331 B. state Generator's to <br /> ii 4. Generator's Phone(209 ) 9192-211'12. <br /> o I B. Trane orte 1 Co n N¢mR @,� US EPA ID Number C. State Transporter'e ID <br /> AT 3V �7r1jt f1AL , i?VIC;ISSq IPa(Fr "? 0 ? ( 3 D. Transporter's Phone <br /> A 3 7. t r, r -t t- <br /> ui 7. Transporter 2 Company Name e. US EPA ID Number E. State Tnnporter's to F. Tramportar's Phone <br /> 0 <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number O. State Facility's ID <br /> B 80 SARIT.AiiY LAhl,,F111 c I A 1 til 9131910141214125 1 <br /> a GGZ V 1 AY CAD H. Facility's Phone <br /> rj VMIAVIt.0- p CA 95683 P A ft 9 PI2 ,' tsf /r171 - (707) 4�1-3275 <br /> -Z12. Containers 13. Total 14. I. <br /> 2 <br /> US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) Quantity Unit Weals No. <br /> � 11. escr <br /> No. Type Wt/Vo1 <br /> v a 20 PX,.AR1N)(1S filets y <br /> Z G EPA/Oma <br /> a H E F <br /> 3 N State <br /> E It. <br /> mp EPA/Other <br /> m T <br /> o O <br /> w R c. State <br /> a <br /> o EPA/Other <br /> m <br /> d State <br /> r <br /> Z EPA/OIMr <br /> U <br /> w J. Additional Descr"rytIons for Materials Lined Above K. Handling Codes for West"Listed Above <br /> ZZ a' 03 i, . b. <br /> g , ,:.frYr ....t. 11, l ,),... . 11 r-' i �+ 0- ..'�. <br /> L <br /> C. d. <br /> L ., <br /> J <br /> Q <br /> Z <br /> P 15. Special Handling Instructions and Additional Information <br /> < IdAR ilflOPF'i? ;t;epi;?A`1.;1?.Y ;T):..11V'+"Tr A1'i) r f'i Tf"CIi1it. :'[ 't3FLif1 <br /> W W ;v41I`)dEAK 1ih:;St AV}I!) Ii.Pf'AVIP:" I;JSCe <br /> J <br /> 18. <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 /> and are classified,packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and <br /> J <br /> a national government regulations. <br /> y <br /> It 1 am a large quantity generator,I cantly that I have a program in place to reduce the volume and toxicity of waste generated the degree have determine <br /> V to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available 10 me which minimizes the <br /> present and future threat to human health and the environment;OR,if I em a smell quantity generator,I have made a good faith effort to minimize my waste <br /> > generation and select the beat waste management method that is available to me and that I can afford. <br /> V <br /> W Printed/Typed Neme St n tura Month Oa Yeer <br /> IJUJI Ir. it' r} 1-X t( '� (� 4t)..�;i.1 , �� ��1 ..'.r r`�l%'�. y <br /> wT 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> RMonth Day Year <br /> Z A Printed/�Ty�p�ed�N�ame J Signature ! ,y <br /> P 19. Transporter 2 Acknowledgement of Receipt of Materials <br /> w OMonth Day Year <br /> T <br /> G R Printed/Typed Name '� Signature <br /> V <br /> E <br /> Z_ <br /> FC <br /> 19. Discrepancy Indication Space <br /> 20. Facility Owner or Operator,9AVification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Print d/Ty d e I S Mont Oa Year <br /> DHS 8022 A Do Not Write Below This Li <br /> EPA 8700-22 <br /> (Rev.8.89)Previous editions are obsolete. <br /> Yellow: TSDF SENDS THIS COPY TO G'JE�T��Q(1�{I S <br />