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State of California—Environmental Protection Agency <br /> Prm Approved OMB No.2050-0039(Expires 9.30-99) So Instructions on back Of a 6. Department of Toxic Substances Control <br /> ~tease print or type. Form designed for use on elite(12-pitch)typewriter• Sacramento,California <br /> UNIFORM HAZARDOUS 1• Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> pis not required by Federal law. <br /> WdSTE MANIFEST $ i �. D A.171416 +� 2 9 0 1 � ! of S <br /> 3. Generator's Name and Mailing Address A State Manifest Document Number <br /> 1 .. TEft INC <br /> 7,14 6 <br /> LODI CA 0240 <br /> i S. C NTO STT3 <br /> B: Mate Geaerafof s ID <br /> to 4 Generator's Phone <br /> p <br /> N5. Transporter 1 Company Name 6. US EPA ID Number C Stge Transporter s 1D Reserved) <br /> �•. <br /> O' °r./ 9 i'L i1M°6F9'y. m' 7. ran3parter'$IhonB . <br /> OP <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E: State.Tronsporter's^ID[Reserved.) <br /> t a <br /> F. Transparfer's Plane <br /> 01 '191 <br /> U 9. Designated Facility Name and Site Address 10. US EPA ID Number `X G. State Facility's ID <br /> Q US E"COLOGY <br /> �g O HWY ..fr t�Mil_I.-S St".?#s I H H. Facility'sPhone <br /> Q12. Containers 13. Total 14. Unit <br /> U 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> No. Type Quantity Wt/Vol f. Waste Number <br /> PION RCRA RAZMDOLJS WASTE,SOLID(PAdNT SOLIDS) <br /> j N e P EPA/Other <br /> b / sr <br /> co 00 E T+ON RCRA HAZARDOUS WASTT«,SOLID D I"9 P � � <br /> Ad I b C3 Cotler <br /> C. State <br /> 0 o NON RCRA HAZARDOUS WASTE,SOLID L3 M <br /> R ff EPA— ther <br /> w d. / Storef <br /> Z <br /> w <br /> U gp y yp� EPA/Other <br /> 1. Ar 3etTt <br /> K. Handling Caries Far Wastes Listed Above <br /> 1 i P £T Tia"�9^i-' t �I«^I�3iT b. tai F <br /> w k_ w <br /> d. <br /> Z 15. S ectal Handlm Instructions and Additional Information ' <br /> EI U"Inlvc' CALL E:NVIROSERV 4-162-427-7277 <br /> Z BILLTO EWRONt*-NTAL RECOVERY SERVICES USE PROPER SAFETY EQUPMENT Eta;W.O 48**H <br /> W <br /> Q16. GENERATOR's CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and'are classified,packed, <br /> U marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> —�+ If I am a large quantiy generator,I certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> N practicable and that I have selected,the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> V and the environment;OR,if I am a small quantity generator,I have To a Faith effort to minimize my waste generation and select the best waste management method that is <br /> O available to me and that I can afford. <br /> r P' /Ted Name, ' Signature f Month Day Year <br /> w B 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> U.1 A Ainted/Typed Name Sign ure r �1onih Da Year <br /> W <br /> O0 18. Transporter 2 cknowleclement of Receipt of Materials JJj1 <br /> LU E <br /> T Printed/Typed Na .>.4 - < /y Signature (g \ �j on h Day p ear <br /> U F 19. Discrepancy Indication Space <br /> � <br /> Z A t / <br /> C <br /> JjJLj l <br /> 20. Facility Owpdr or Operator Certification of receipt of hazardous materials covered by t s manifest except as noted in Item 19, j <br /> Printed/ Na Signatu[eM/�nth ay Y r <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A(1/99) (Generators who submit hazardous waste for transport out-of-state, <br /> EPA 8700-22 produce completed copy of this copy ani send to DTSC within 30 days.( <br />