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State of California—Environmental Protection Agenc <br />Form Approved OMB No. 2050-0039 [Expires 9-30 99) <br />Please print or type. Form designed for use on elite 112-pi0 riter. <br />See Instructions on back or le 6. Department of Toxic Substances Control <br />Sacramento_ Cnlifnrnia <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) I Yellow: GENERATOR RETAINS <br />EPA 8700-22 <br />UNIFORM HAZARDOUS <br />UNIFORM HAZARDOO� <br />1. Generator's US EPA ID No. Manifest Document No. <br />2. Page 1 <br />In Formation in the shaded areas <br />WASTE MANIFEST <br />4 <br />IAL it) I %L ().1 C. <br />% <br />of / <br />is not required by Federal law. <br />Generato Nam�/ n'd Noifin ddre s <br />� 4r Ye..,./•r ,. <br />T v r T <br />-, 7� � �-<,:D <br />Cly_ %t „ <br />to Manifest Document Number <br />22920177 <br />,r� <br />fTti, ,r 71an tM l?` it <br />75 <br />/R.:.et,, i!F <br />B. State Generator's ID <br />r 4. Generator's Phone ( qtr) L r <br />Ff <br />(, Y/ (n i. r nu L✓ ' <br />5. Transporter 1 Company Name <br />6. US EPA ID Number <br />C. State Transporter's ID [Reserved.) <br />YRa�TAL. <br />UC ~ <br />D. Transporter's Phone <br />15101267-0134 <br />7. Transporter 2 Company Name <br />B. US EPA ID Number <br />E. State Transporter's ID (Reserved.l <br />DK P,tchnlcmd <br />F. Transporter's Phone 510 231-12301 <br />9. Designated Facility Name and Site Add e <br />10. US EPA ID Number <br />G. State Facility's ID <br />>x WMIROWNSMAZ <br />3650 BUT 26TH ST • <br />H. Facility's Phone <br />"ON, CA 90023 <br />(323)268-5036 <br />11. US DOT Description (including Proper hipping <br />Name, Hazard Class, and ID Number) <br />Containers <br />13. Total <br />Quantity <br />14. Unit <br />Wt/Vol <br />I. Waste Number <br />No. <br />No <br />Type <br />q� .i..,_. <br />4on— �' �► Haz 71ix..�4 s <br />'Waste .�d�.id <br />Slate <br />C � <br />EPA/7c <br />.1,A <br />/ r <br />/ <br />E <br />N <br />b. <br />State <br />E <br />R <br />EPA/Other <br />T <br />C. <br />State <br />O <br />R <br />EPA -/Other <br />d. <br />State <br />EPA/Other <br />J A tional D acriptions for Mate ' s este <br />*or , rags, 3 <br />ve <br />°h coil and gma-s0 <br />K. Handling Codes for Wastes <br />Listed Above <br />a. <br />b. <br />C. <br />d. <br />euK4a�li p�Fl c1dE M 6j and t lit <br />i <br />I rpa4pf wog pWNT <br />AVb510 <br />` 4 NOUR M —TOM <br />267 01134 � a <br />S, - !!(^ �U �"�ji' t. ��� 4 <br />:'' P?„ ,� > ti, .• �, ,. s e `> i' � ! % :, !i!`� n t � •!` �y7 .� .;_, C` �) <br />16. GENERATOR'S CERTIFICATION: I here. <br />cleclar that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, <br />marked, and labeled, and are in all resp <br />cts in proper condition for transport by highway according to applicable international and national government regulations. <br />If I am a large quantity generator, I certi <br />and that I have selected the <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 economically <br />acticable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health <br />practicable <br />and the environment; OR, if I am a small <br />rl <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 />,s <br />Printerfi/Typed Name >'' //, <br />Signature : _ - <br />Month .\ ..pay -y-- Year <br />T <br />17. leansporter 1 Acknowledgement of Feceipj <br />of Materials <br />R <br />A <br />Printed/Typed NamV, f <br />Signature / <br />Month Day,— Year <br />P <br />0 <br />18. Transporter 2 Acknowledgement of Recei <br />of Materials <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 />1 <br />20. FacilityOwner or Operator Certification <br />of ecei t 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 />Y <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) I Yellow: GENERATOR RETAINS <br />EPA 8700-22 <br />