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orate ot unitamia—brivironmental Protection Agency 1 1 Form Approved OMB No. 2050-0039 (Expires 9-30-99) See Instructions on back of page 6. Departinent ofrio Please print or type. Form designed for use on elite (12-pitch).- writer.
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<br />c Substances Control
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<br />WASTE MANIFEST
<br />UNIFORM HAZARDOUS
<br />merator's US EPA ID No. ., Manifest Document
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<br />Generator's Name and Moiling Acktress fg, '-c-(..) ' 4. A. State Manifest Document
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<br />Transporter 1 Company Name . 6. US EPA ID Number xviatratim MVIR0,41110+rfAL C. State Transporter's I (Reserved]
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<br />SIKRVICES "C I A' D1 9 1 81 21 41 11 31 :', 612 I). Trcmsporter's Phone 510/795— . . 0,-
<br />7. 4171Taf'clItittertitarlOt4 A. 8. US EPA ID Number .State Transporter' s ID (Reserved,.1 1
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<br />9, Designated Facility Marne and Site Address 10. US EPA ID Number
<br />7.3T (KITTWURY , Rm.
<br />2095 IDNIANDS DRIVii,t FAST
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<br />Ff. Facility's Phone... . Ti5-575--2780
<br />) (12. 11. 1.4 90T Description (including Proper Shipping Name, Hazard Class, and ID Number) Containers 13. Total 14. Unit
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<br />J. Additir ial Descrfor Materials Listed.Above
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<br />15 Special Handling Instructions and Additional Information E-R.GI
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<br />16 GENERATOR'S CERTIFICATION: t hereby declare that the contents of this consignment are fully and accurate y described above by proper shipping name and are cless+d marked, and labeled, and are in all respects in proper condition for transport by hi ghway according to apt licoble international and national government regulations.)
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<br />If I am a large quantity generator, I certify that I have a prog ram in place to reduce the volume and toxic :ty of waste generated to the deg ree I have determined to '-e practicable and that I have selected the rociitalste method of treatment, storage, or i disposal currently one liable to me which minimizes the present and future threat,* and the environment; OR, if I am a sm !quantity generator, I have made a ,htilth effort to minimize my waste generation and select the best waste managemet aypilable to me and that I can afford. ;
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<br />R 17. Transporter 1 ment of eipt of Materials
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<br />/77.•1 $ I 8. T sporter 2 Acknowledgement of Receipt of Materials
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<br />19 Discrepancy Indication Space
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<br />f 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19
<br />T Y Printed/Typed Name Signature Month
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<br />Day Year
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<br />DO NOT WRITE BELOW THIS JIVE.
<br />SC 8022A (1/99) GENERATOR SEN
<br />A 8700-22 P.O. Box 400, So
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<br />S THIS COPY TO DTSC WI) ii
<br />ramonto, CA 9.58 1 2-04001
<br />il 30 DAYS.
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