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State of Califomia—Environmental Protection Agency <br /> For�m.Approved OMB No.2050-0039(Expires 9-30-99) See I11struCeidns' 011 back 6: Department of Toxic Substances Contra <br /> PPfegse• rant or type. Form designed for use on elite f 12-pitc,., der. o Sacramento,California <br /> UNIFORM HAZARDOUS 1. Gener°f°r}s try ik It No. M99Xest Document No. 2.:Page 1 Information i the.sfiaded areas <br /> is not required by federal law. <br /> WASTE MANIFEST lf,10?1r:. 9721 of .1 <br /> 3. Generator's Name and Mailing Address H. JHF INN r•A. State Manifest Document Number t <br /> 280�0 S .Cy `� "ALLIFORNIA � 229492 -Ij <br /> P. O.. BOX ] 'B- State Generotor's ID — — <br /> to r fNe, CA 95206 <br /> 204 932-5759 <br /> CV 5. Transporter 1 Company Name 6. US EPA ID Number C. .Slafe Transoorter''s ID[Reserved.I ., <br /> 00 <br /> o SAFETY—KLEEN SYSTEMS . INCT 0; Q _ 0 $ D Transporter',Phone <br /> O <br /> °O 7. Transporter 2 Company Name 8. US EPA ID Number E State Transporter'sID[Resew I <br /> i <br /> rr - � 'F. Transporter',�Phoiie <br /> 9. Designated Facility Name and Site Address . 10. US EPA ID Number G. State radiiry's ID <br /> d .050035 5, 21': <br /> ZA E R C COMINC <br /> INC H. Facility's Phone <br /> O 0 30677 HUNTWOOD AVE C D9 . 243 I" <br /> j HAYWARDr A00 ') ?fi- If-1 <br /> J IJ <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total. 14. Unit <br /> (aj P ( 9 P Pp 9 RIo. Tye Qu6nlity Wt/Vol 'I Waste N mh r <br /> Z a. — <br /> - ' State <br /> RQ P WASTE BATTERIES, WET, FILLED- WITH � <br /> G ALKALI <br /> EPA/Other <br /> E PG ITT DO 0 9 if FPGAS4 0 <br /> �+ N b. st to <br /> 0 <br /> oo E <br /> a R EPA/Other <br /> v A <br /> o T C. <br /> Srare <br /> 00 O <br /> R EPA/O'lier <br /> LU d. State <br /> Z <br /> w EPA/Other <br /> � I I <br /> W <br /> N J. Additional Descriptionsfor Materials Listed'Aoove K,.Hondling Codes for Wastes listed Above <br /> Z <br /> a ! 1 b <br /> LU <br /> 0 1.5. Special Handling Instructions and Additional Information <br /> QNFST R/T4104155820 0002-2481-68 <br /> Z EMERGENCY RESP 800-468-1760( 24 MR ). IF UNDELIVERABLE RETURN. '�O .G7N1"RATOR. <br /> w SK. CORP AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY. <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents o t is consignment are fully an accurate y described above by proper shipping name and are classified,packed, <br /> Q marked,and labeled,and are in all respectf in proper condition for transport by highway according to applicable international and national government regulations. <br /> J If I am a 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 economica11 <br /> N practicable and that I have selected the practicable method of tretment,.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 quantity generator,I have made a good faith effort to minimize my waste generation-and select the best waste management method that is <br /> 0 available to me and that I can afford: <br /> } Printed/Typed Name Signature ILI, 7 Y Month Da' Year 1 f <br /> Z - V - xp. <br /> LLJ <br /> LT runs orter 1 ckna ed ement of Receipt of Materials <br /> R <br /> W A. Printed/Type me r" iy1y. °lure Month Jay YearP <br /> LLJt�z 7-S <br /> { ) ! <br /> U- 0 18. Trans orb r Acknow ed emenf of Recei t of Mafer s ....._.> . <br /> T Printed/Typed Name Signature Month Day Year <br /> N �y.�-1 <br /> L.Q <br /> Vscrepancy ndtcation-Sp ce <br /> Z r <br /> f <br /> .� `FEB <br /> [ l:aci flSvl ECar_O arator CertiFieaiion'of receipt of hazardous materials covered s manifest except as noted in Item 19. <br /> T Pr ted/Typed Name SiBnaf Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> PgqR+Q�L# A)0200021599 Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DT5(:�042T /9A)00400 3 5 204 (Generators who submit hazardous waste for transport out•of=state, <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />