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CAMR 31092 <br /> State of California—Environmegtol'Protection Agency 1 <br /> Form proved OMB No.2050.O%39(Expires 9.30.99) S@e Instructions on back of a b. Department of Toxic Substances Control <br /> Plebs.,prusir type. form desi d for use on elite(12•pitch) itec Sacramento,California <br /> Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> W " UNIFORM HAZARDOUS is not required by Federal low. <br /> w_ WASTE MANIFEST hD '10 17 14 16 14 12 3 10 11 ! of 2 <br /> 3. Generator's Nome and Mailing Address <br /> l ZODI <br /> 0 2 8 8 5 1' <br /> 240h <br /> Reneratgr'si 4e j - ; <br /> N <br /> S. Transporter 1 Company N"me 6. US EPA ID Number <br /> srt . s. <br /> a, VMJ &; S INC <br /> �oO �I U Q L O 9 2 5 ? 6 <br /> ao 7. Transporter 2 Company Name 8. US EPA ID Number <br /> yt U 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> Q STECK RWIRONHWCAL CORP TIS <br /> :I Z BOX 111 <br /> DU_ KS 66796pi 1918101,51313 21519 <br /> 'jQ 12. Containers 13. Total 14. Unit <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> V No. T pe Quantity Wt/Vol <br /> IUZ a. s AL <br /> OOgnly01 D035), <br /> 3 G 1,27 M r ; <br /> 253, FCS 3<3"tr (RQ,_).00), '( 2A <br /> N R (iR6 127) iIt D IM <br /> v ..A <br /> TC. <br /> 00 O <br /> R <br /> W a. <br /> Z <br /> W <br /> V . <br /> , <br /> W <br /> J <br /> Q <br /> 0 15. Special Handling Instructions and Additional Information WAMA e .%. <br /> aL i CBMKM=t 3.-8030-424=3 ST TV01=71 .VM WLTM ft. <br /> LU 11A. VA38633, 118. 10733-VA02 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment ore fully and accurately described above by proper shipping name and are classified,packed, <br /> Vmarked,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 amp large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> LO prgcticable and that I have selected the racticable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> antfathtf environment•,OR,if t am a small quantity generator,I have made p good faith effort to minimize my waste generation and select the(rest waste management method that is <br /> available to me and that I con afford. <br /> 0 r r- <br /> Printed/T ed Name Signdture y .. Month Day Year <br /> Z ' <br /> W . 8 17. Trans orter 1 Acknowled ement of Recei i of Materials "� d <br /> w RA Printed/Typed Names_ Signature. Month Day Year <br /> S <br /> Uj <br /> LL_ 0 " 16.""Transporter 2 Acknowled ement of Receipt of Materials 1.,•' f <br /> 0R. Printed/Typed Name Signature Month Day Year <br /> T . <br /> t) .712 <br /> 4Y. Discrepa <br /> Z Indication Space <br /> F <br /> — ;Q <br /> f 20. Facili Owner or O e for Certification of recei t of hia ous materials vered b this manifest exce hos noted in Item 19. <br /> Printed/Typed Name ° S�tgn ture ; Month Day Year <br /> DO NOT WRITE BELOW IS LINE. <br /> DTSC 8022A(1/99) White: TSDF RETAINS <br /> EPA 8700-22 <br />