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Saa of California-Em(tionmental Protection Agency v <br /> Farm Approved OMB No.2050-0039(Exp;,A 9.30-94) See Instructions on back of a 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12-pitch)typewriter. Sacramento,California <br /> 1. Generators US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS <br /> is not required by Federal law. <br /> WASTE MANIFEST of <br /> 3. Generator's Name and Mailing Address ' ' V V u J State'Manifest Document Number <br /> .I r 5 <br /> W') H.J.HEIN7 CO. <br /> B. State Generator's ID <br /> n S <br /> N a8�er§OSUA ,eqali)furc:ia st': Stoc�cton,ca. 95206 <br /> r;4,3 <br /> p 5. Transporter 1 Company ame ' ±tI`sra lJS J EPA ID Number C. State Transporter's ID <br /> O <br /> 00 <br /> D. Transporter's Phone <br /> 09 <br /> ransporler T om any"Na e ` s' A m r i -- E. State Transporter's� -t !-00 <br /> U -F. Transporter's Phone <br /> 'Q <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> CROSBY AAID OVERION <br /> J <br /> 1630 w.17th S t. H. Facility's Kone <br /> Q T L n - <br /> U - v 12:Containers 11-Total 14, Unit <br /> 11. US DOT Description(including Proper Shipping Name, Hazard Class,and ID Number) <br /> Z No. I Type Quantify Wt/Vol I. Waste Number <br /> = a. State == <br />.� G EPA/Other <br /> 000 N T .c � Sfafe <br /> co E su�Ssq q <br /> N R - L�W. F11:w.�5 FiEC�.iVED,HANDLED AND Sow lllt•w uNO; EPA/Other <br /> v (7R KRS@ CitE1SdY k OVERTON,INC.op Sw h 04 G <br /> A <br /> 00 T C. "Am-n".BY { 91 CDRDA N, 1CA8 State <br /> co at AL rrtcT.��toP A� t9Ts To <br /> R tyATION k IiECWfxY ALT N HAS OF . •1�SSAR <br /> X., LA <br /> E1OS6Y L OV IYA F 8 4 HA'p_ EPA jOther <br /> Lu & wti11rR Af�9 b+brlrre <br /> Z d. t; y 4 State <br /> I <br /> U EPA/Other <br /> Lo <br /> Z J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> CL <br /> V) a. �r�?c_n t��r-:zxcmeter labpa ;c> C. <br /> �. : <br /> 0 15. Special {candling Instructions and Additional Information <br /> f— <br /> Q _ <br /> Z ERG: 1 /L <br /> w <br /> 1 b ZEERTIt`I ZtfO ;ecreiy declare fha a cin a df thE��arn'sigMr n sj fuflyr 'nif-accurately described above by proper shipping name and are classified, <br /> G�MA <br /> Qpacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international laws. <br /> U `, <br /> 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 <br /> -' 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 <br /> threat to human health and the environment;OR,if I am a small quantity generator, I have fnade a good faith effort to minimize my waste generation and select the best <br /> waste management method that is available to me and that I can afford. <br /> O Printed/T ped Name Signature Month Day Year <br /> U - <br /> Z T 17. Trans orter 1 Ackno eent of d emRecei t of Materials <br /> R <br /> 0 N Printed/Typed Name/ r Signature /!�� `.^ /' l Month Day Year <br /> = s P 24 <br /> t i rj i' q <br /> ::E 0 1 . Tra`hs'porter 2 Acknowled emelt of—Receipt of Materials <br /> LU R Printed/Typed Name Signature- �� Month Day Year <br /> E 7/_ <br /> w T9. DisFre-pancy Indication pace <br /> V <br /> Q F <br /> U A <br /> Z C <br /> I <br /> L <br /> I 20. FacilityOwner or Operator Certification of receipt of hazardous materials covered b this manifest except as noted in Item 19. <br /> T Printed/Typed Name - Signature Month Day Year <br /> Y <br /> - DO NOT WRITE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A (7/92) (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 />