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S of California-Environmental Protection Agency EoFProv`ed OMB tJo.!2050-0039(Expires 9.30.94) See Instructions on back Of a 6.��S deportment of Toxic Substances Control Please print or type. Form designed for use on elite(12pifch)tyr._..riter. Sacramento,California UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas is not required by Federal law.. WASTE MANIFEST of � T 3. Generator's Name and Mailing Address :I State Manifest Document Number in9O •t H H-in. 8. State Generator's IO C� a8t er �e(Fal'fornia st. Stoc kton,ca. 95206 00 r p 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID O 00 D. Transporter's Phone c ransporter Company, ame ++ $ A umber ` - E. State Transporter's ID 'r Uf' 7 1 F. TranspoAer's Phor,prr'. +� ....•� ZDesignated Facility Name and Site Address 10. US EVA'ID-tdumber G. State toeility' /. r: r J '7 o Lijhtin.g R�sourcas,Inc. 4 y`7 `—` 7.522 East Victory St. •"'7 H. Facility's Phone 7DD'� n n' - '7 r. r - c +n 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers i�.Vital•" `14. Unit Z No. I Type Quantity Wt/Vol 1. Waste Number .� a. State 3 RQ HA2.ARDOUS WASTE SOLID NOS,9,UN3077 FGIII EPA/Other, G (low mercury Vapor bulbs) 0 011 D IF 31 10 101015 DOO9 �i E do N b. State 00 E v C14 R EPA/Other T C. State r- O R EPA/Other Lu ~ d. State Z w U EPA/Other Lu N Z J. Additional Descriptions for Materials Listed Above J. K. Handling Codes for Wastes Listed Above Ila. 14.oulbs in labpaC'tC ,�--l��+:t^� f, a. Q b. LU CY C. d. Q Z Q 15. Special Handling Instructions and Additional Information a Z erg: 172 ` W = a;;.;ro,)riate � It- - 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described`above by proper shipping name and are classified, packed marked,and labeled,and are in all respects in proper condition for transport b highway according to applicable federal,state and international laws. a P P� P P P Y 9 Y 9 PP• U If I am a large quantity generator, 1 certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I hove determined to be -r economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future Nthreat to human health 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 CX waste management method that is available to me and that I can afford. O Printed/Typed Name Sig a 7 Month Day Year Z T 17. Transporter 1 Acknowleagement of Receipt of Materials UjN Pri ed/Typed Name Signature., / ' Month Day ^Year w vi.q (� t 1 �..�v^ �. ( ✓1( ;j Jr/. C Yi.� LU 0 18. Trans orter 2 Acknowledgement of Recei of Materials LU a Prime /Typed Name C , SignaturiF` \( (� Month Day Year R LLJ N I(ILD 19. iscrepar�ry Indication Space C-P. y : �f�4-- ODUESZ-1-.-5-e U A X461//77 A4:4 titCSOGIFeGs, /�Ci e . Z t"7 A 77. 1'- 20. Facility Owner or Operator Certification of receipt ofhazardousTnaterials covered by this manifest except as noted in Item 19. T Printed/Typed Name Signature i' Month Day Year Y _ 1 DO NOT WRR BELOW THIS 11K. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. DTSC 8022A (7/92) (Generators who submit hazardous waste for transport out-of-state, EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.)