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Stole California—Environmental Protection Agency <br /> A / <br /> Foam Approved OMI No.2050-0039(Expires 9-30.99) See Instructions on back of pa I// Department of Toxic Substances Control <br /> Please rtnt.or4pd Form designed for use on elite(!2-pitch)it ter. Sacramento,Californio <br /> 1 Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS �[l (/ is not required by Federal law. <br /> WASTE MANIFEST L D 0 0 2 S 6 3 V of <br /> 3 Generator Noma an coling Address A. St le Manifest Document Number <br /> /�.�.ca+�c,r o� , Z-1c, 22923142 <br /> /,LT�� S� ,/ ` r' �O�r-" B. State Generator's ID <br /> LO <br /> _VC95j60✓LVt7� JZZ2Y <br /> W) �L. aria ors ✓Wore I y <br /> t\ ~ <br /> CV 5. Transporter 1 Company ame 6. US EPA ID Number I C. State Transporter's ID[Reserved.] <br /> W) <br /> CP DTransporter's Phone <br /> - IC 12 In la 12, 4 %' Is I <br /> CI 11^ 7. Transporter 2 ompony Name 8. US EPA ID Number E. State Transporter's ID[Reserved. <br /> J F. Transporter's Phan <br /> V 9. esignate Facility N me an Site Address 10. USIPAIlDn. &, G.CIQ Slate ility's ID <br /> Z H. Facility's Phone <br /> 0 - M--Zt%, ca nsl s o <br /> �T - ;S Tdi 0 �, D J 0 b <br /> -� 12. Containers 13. Total 14, Unit <br /> V11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol 1. Waste Number <br /> i <br /> / L /wyyA[ State —J,3 <br /> /IV/ ✓wv/ EPA/O/' <br /> E b State <br /> o N <br /> ao <br /> c0 E EPA/Olher <br /> (V <br /> -4 R <br /> A c State <br /> o T <br /> ado 0 EPA/Other <br /> R <br /> State <br /> w d. <br /> Z <br /> w EPA/011ier <br /> V <br /> W <br /> V) J. Additional Descriptions for Materials Listed Above K. Handling Codes far Wastes Listed Above <br /> Z - a) A6+o•S, Oc 6rio�• w�d. � 19'I I b <br /> Uj <br /> Uj <br /> d. <br /> J <br /> Q - <br /> Z j.,9 Speci Hand Instructions an Additional Irs{or tion <br /> 0 rv� �xrprz >P�aeo ersonL 3�3l <br /> Q <br /> Z 21 :M, ti: V. L�lle�pior (320) 207-02.s� site. �r►+tfA�.� Qaile� ew.0 <br /> w <br /> 16 GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described obove by proper shipping name and are classified,packed, <br /> Q marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and notional goverrmenl regulations. <br /> i <br /> V <br /> If I am a large quantify generator,I certify that I have a proggrom in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economtcalfy <br /> w practicable and that hove selected the practicable method of 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 quantity generator,I have mode a good faith effort to minimae my waste generation and select the best waste management method that is <br /> available to me and that I can offord. ' <br /> Oinn /Typed N me n t a Mo h Da Year <br /> Z o <br /> l�e� ti C> <br /> LL' T 17. Trans art 1 Acknowled amen•of R-1of Materials <br /> R Month Day Year <br /> w p Printed/Typed Name Signature D <br /> ::� 0,—, d <br /> w P <br /> w 0 18. Tra orter 2 An ow edgemerI of Recei t of M erials <br /> 0 R Print ed ame Signature /1ntF Year <br /> T � <br /> Lu E ! i/ <br /> V) R <br /> < c cation Space <br /> A <br /> C <br /> 20. Facility Owner or O rotorZRn of reciiiitiiii�eipt 01 hazardous me'erials rovers is est exce t as noted in Item 19. <br /> T Printed/Typed Name , gnature jon1n Day Year <br /> Y <br /> DO NOT RITE BELO THIS <br /> White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DTSC 8022A (1/99] To: P.O. Box 3000, Sacramento, CA 95812 <br /> EPA 8700-22 - <br /> e.--7— ."^` ..a. 14, 777 <br /> j <br />