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! State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9.30-0h See Instructions on back ofawne 6. Department of Toxic Substances Control <br /> Please print or type. Form designed For use on elite(12-pitchriter. Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST <br /> 4 7 of snot required by Federal law. <br /> 3. Generator's Name and Mailing Address <br /> TES M � <br /> 1 <br /> LMI <br /> LMI1 C4 W) A. Generator's P one ( Catwit: JIME FLEMRy r 1 <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number x <br /> RMCOD <br /> EPI AL TECH. J c 6 d / k v. k a' <br /> O <br /> 00 7. Transporter 2 Company Name 8. US EPA ID Number �� tasePti r i T W <br /> —+ ��9ts � a <br /> JIMPF•� ti �� 4P� Zi3'e y fi ¢ <br /> V 9. Designated Facility Name and Site Address 10. US EPA ID Number * TZK" r ' ' <br /> qT Z X1 w EI8IR0btdA'.Xc 7 A S GCC <br /> Art �; ".Y <br /> ' p 2061 DAY MAD � V, � 4 S 2 6UST PAW ALM 94303 . <br /> -+ 12. Containers 13. Total 14 Unit <br /> V Wt/Vol <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) rm <br /> No. Type Quantity <br /> Z -WASTE PAINT MATED UTEETAL 3 UR263 i$ <br /> 3 G Pd1# E 201456 Effit 127 f f Pf <br /> o M 6VA A <br /> coCE <br /> v A U11W III <br /> pRESIDUSt LW qy <br /> 00 0 <br /> R Prf1# E 301247 M 1 <br /> LU d. <br /> Z <br /> V <br /> LU <br /> � R <br /> Z 15. Special Handling Instructions and Additional Information <br /> 0 <br /> t- <br /> Q <br /> Z <br /> w <br /> 2 <br /> 16. GENERATOR'S CERTIFICATION: I herebydeclare that the contents of this consignment are full and accurately described above by proper shipping name and ore classified,packed, <br /> Vmarked,and labeled,and are in all respcts in proper condition for transport by highway according to applicable international and national government regulations. <br /> J <br /> J If I am a large quantity generator,I certify that I have a program in place to r ce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> N <br /> practicable and that I have selected the racticable method of treatment,store o isposal currently available to me which minimizes the present and future threat to human health <br /> and the environment;OR,if 1 am a small quantity generator,1 have made a good fa h 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 /> OPr' d Name it) 16 10 1Z 19 Signoture / / % /ff Month Day Year <br /> Z <br /> w <br /> � T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> w p n e ped Name Sig Lure <br /> U_ 0 1 B. Trans orter 2 Acknowled ement of Receipt of Materials <br /> T Printed/Typed Name Signature Month Day Year <br /> w E <br /> to R <br /> (Qj 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> G <br /> i <br /> L <br /> ) 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> j Printed yped Name Signature Month Day Year <br /> Referewa E ert. E 0OW26572 DO NOT WRITE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> -0TSC'8022A f1/99 (Generators who submit hazardous waste for transport out-of-state, <br /> produce completed copy of this copy and send to DTSC within 30 days.) <br /> EPA 8700-22 <br />