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State of California—Environmental Protection Age 3c <br />Form Approved OMB No. 2050-0039 [Expires 9-3099) <br />Please print or type. Form designed for use on elite 12-pitcf ,iter. <br />C <br />Lr <br />I'll <br />tr <br />a <br />C <br />C <br />-4 aC <br />it <br />Q <br />Vz <br />C <br />V" <br />Q <br />Z <br />H <br />3 <br />N <br />O <br />cc <br />00 <br />74 <br />V <br />O <br />O <br />00 <br />w <br />Z <br />w <br />V <br />ss <br />d <br />N <br />W <br />J <br />Q <br />Z <br />O <br />Q <br />Z <br />LU <br />H <br />Q <br />V <br />J <br />N <br />O <br />} <br />U <br />Z <br />w <br />LLJ <br />O <br />LU <br />c/7 <br />Q <br />V <br />See Instructions on back o' le 6. Department of Toxic Substances Control <br />DO NOT WRITE BELOW THIS LINE. ^ KG ` -14- 3 <br />DTSC 8022A (1/99)I Yellow GENERATOR RETAINS <br />EPA 8700-22 <br />UNIFORM HAZARDOUS <br />1. Generator's US EPA ID No. Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />WASTE MANIFEST <br />C 't. <br />C- <br />is not required by Federal law. <br />�} <br />of <br />3. Genet tot's Name Rd Mailifig Addre 's <br />^ ��6�:�AC <br />ri' 6 7 ' • <br />�t�1.,) <br />A. State Manifest Document Number <br />22920181 <br />r r( ��, � / <br />`(j L-.' /< ..; C2 I/, //r, / %+? I �3 7 <br />B. State Generator's ID <br />4. Generator's Phone ] %[7) ` <br />e) - '� f� ', r i'-' fir . �� . jn J e~ j <br />5. Transporter 1 Company Name <br />6. US EPA ID Number <br />C. State Transporter's ID [Reserved.] <br />MO� "V11RO NTAL. <br />INC•' A i 0 8 0 0 1 3# 8 <br />D. Transporter's Phonet510) 267-0134 <br />- <br />7. Transporter 2 Company Name <br />8. US EPA ID Number <br />E. State Transporter's ID [Reserved.] <br />tiXK Ridbloolld0 <br />Q <br />F. Transporter's Phone <br />jXjlj pnd Site Add es <br />s 10. US EPA ID Number <br />G. State Facility's ID <br />2000 0. A].ame" St, <br />CoWtc)n f C& 90222-279 <br />C A T 0$ 0 0 1 3 3 5 2 <br />H. Facility's Phone (314) 337-7100 <br />11. US DOT Description (including Proper hipping <br />Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />Quantity <br />. <br />14UnitNo1m] <br />Wt/Vol <br />I. Waste Number <br />Type <br />a. <br />id. <br />State <br />G <br />EPA/Other <br />Nb. <br />G '+'r�, ¢n•iM <br />O a,U ,,_ S /).O - <br />State <br />Rj <br />EPA/ e <br />TC. <br />State <br />O <br />R <br />EPA/Other <br />d. <br />State <br />EPA/Other <br />ctipt atJOKIRst <br />K. Handling Codes for Wastes Listed Above <br />a. b. <br />C. d. <br />pec d ri r c i' nd <br />f a in <br />24 HOUR CONTAM -'iUOMN4 <br />tU01 810 267 0134 <br />/ <br />16. GENERATOR'S CERTIFICATIO I here <br />declarl that the contents of this consignment are fully and accurate)y described above by proper shipping name and are classified, packed, <br />for by highway international <br />marked, and labeled, and are in all resp <br />tIs in proper condition transport according to applicable and national government regulations. <br />If I am a large quantify generator, I cern <br />that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economic 11 <br />practicable and that I have selected the <br />acticable 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 <br />quantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br />available to me and that I can afford. <br />; 1 <br />Print d/ped Name r <br />Signature 1r r� <br />Month ' ayear_ <br />TR <br />s 17. Tra orter 1 Ackno led ement of Recei <br />of Materials <br />A <br />I <br />Printed/Typed No / <br />yam, <br />'Signature <br />Month Day- Year <br />11 <br />�,yYrl. ,;. <br />,� <br />r v <br />P <br />1 <br />18. Trans orter 2 Acknowled ement of Recei <br />oI Materials <br />R <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />20. Facility Owner or Operator Certification <br />of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />r <br />DO NOT WRITE BELOW THIS LINE. ^ KG ` -14- 3 <br />DTSC 8022A (1/99)I Yellow GENERATOR RETAINS <br />EPA 8700-22 <br />