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4.t�.otf Ce 6rnia—'Environmental Protection Agency /! -
<br /> "For�Approved CZIv1B'1Uo.2050-0039(Expires 9-30-99) See Instructions On back of. :6. Department of Toxic Substances Control
<br /> PIeS�nt 13r,tete, Fo.}�m designed for use on elite(12-pitch)tyt er. Sacramento,California
<br /> 1.•Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas
<br /> UNIFORM HAZARDOIJ "¢ a C as is not required by Federal law.
<br /> WASTE MANIFEST J /I ZI b 01 01 41 10ZP of e 1!Z1 »,
<br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number "� '.1A#DEIN U S A
<br /> P.0,BOX 57,STOCKTON,CA 95201 2085469
<br /> O: B. State Generator's ID --
<br /> Lo A. G'enerator's Phone ( ) Attn: OAVE &AVER
<br /> N 5. Transporter�1'Company Name 6..-US EPA ID Number C. State Transporter's'llY[Reserved.]
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<br /> 0 .. - int, D. Transporter's Phone �". 640-444V
<br /> 7..Transporter 2 Company Name - 8. US EPA ID Number E_Shate.Transporter's 1D[Reserved.] -- —
<br /> spy F..Transporter's Phone. ,,,�, r
<br /> 9. Designated Facility Name and:Site Address 10. US EPA ID R6m6er G. State Facilit 's ID '
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<br /> -� 6426 Hay - H. Facility's Phone 6 ,w
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<br /> V 1 -US DOT Dec p ion(including Nrop Shipping Name,Hazard Class and JD Number) 12. Containers 13. Total 14. Unit
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<br /> No. Type Quantity Wt/Vol I. Waste Number
<br /> RO...Aubesto3,9.fdA22i 2,PG!It (C•tle` $7f}'; � Stateg15
<br /> �. ,G - - :•ar `- + ). Y EPA/Other 's
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<br /> J. Additional Descr tions for Materials Listed Above
<br /> Z Pa K. Handling Codes For Wastes Listed Above
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<br /> Z 15. Special Handling Instructions and Additional Information
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<br /> z EMERGENCY CON T A'CT: CHEMT TEC P.C. N: (800) 424-9300
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<br /> Rke'06(— p addr”,%: 2 S.CAL.11=t RNIIA,ST STOCKTON Cry 95206 job a 9273
<br /> Q16?GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by' per shipping name and are classified,packed,
<br /> V marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations.
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<br /> If I am a large quantiy generator,I certify that]have'a proggram in place to reduce the volume and toxicity of waste generated to the degree I have determint.to be economically
<br /> N, practicable and that I have selected the practicable method of treatment,-storage,or disposal currently available to me which minimizes the present and future threat to Kaman health'
<br /> and the environment;OR, if I am a small quanitity generator,1.h.oveimgde,a good faith a fort to r%inimize my waste ge�erotion and'select the best waste management method that is
<br /> r .. �. ..r .1,
<br /> O available tome and that I can afford. `..
<br /> } Printta<Typed Name Signature 7 Month Day Year
<br /> 1Ja R 17. Transporter 1 Acknowledgement of Receipt of Materials
<br /> U.1 'N. Print /Typed Name Signature�ww *�"**..�i Month Day Year
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<br /> LL_ 0 18. Transporter 2 Acknowledgement of Recei t of MaterialsIR
<br /> T Pri ed yped N me r'' jsipa t(4 s r F Month Day Year
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<br /> V19. Discrepancy Indication Space
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<br /> 20 Facility O,,Jperor O efato Cert ication gfrrecei t of hazardous materials covered by thio,manifest exce t as noted in Item'1.9 47
<br /> T Printed/Typed Name - Signature ; `:: '. ''�'- / nth•^': D' J Year.
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<br /> DO NOT WRI +E.'BELOW THIS-LINE. '
<br /> DTSC 7022A(1/99) Yellow: GENERATOR RETAINS
<br /> EPA 8700-22 .. �;' ,
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