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q ` e of CaJj,fornia—Environmental:PrcitectioN Agency' For Approved 0}v1B`N 2050-0039(Expires 9 30,99) See Instructions on back of _• 6. Department of Toxic Substances Control Ple p�jt t 6,r, e. Fc�n designed For use on elite(12-pitch)ty, ter. S Sacramento,California #A 1. Generator's US EPA ID No. Manifest Document'No. 2. Page 1 Information in the shaded areas UNIFORM HAZARDOUS" a a ra ^ w �s Q g is not required by Federal law. WASTE.MANIFEST ' L,. if Lf V1 "I -a 11 Z � Afw ® 'V of + �—� enerator's Name and Mailing Address A. State Manifest Document Number NN R0.BOAC 57,STOCKYON,GAA '05261 i2085269 LO - B.:State Generator's ID LO 4 Generator's Phone i 201. J3m+752 Akn: DAVE; SAVER s(V 5.Transporter`1'Company Name -6. us EPA ID Number C. State.Transporter's ID(Reserved.) ao ARS,Ino,, p - 11192 D. Transporter's Phone O 7.`_raniporter 2 Company Name _ _ „. ; —US EPA.ID,N-umber::_. _ E:.State Sransporfer's ID[Reserved.] l J af'� '" F. Transporter's Phone 4-,/,T es r 9. Designated Facility Name and Site Address 10. US EPA ID umber G. State Facili y's D a S 6 J L.arlx> r �''+p �n Q 71 lieuiralf*,CA 85687 j. 0. H:r racility's.'Phone r (70�+g) 7Lyy�t' f. 92 u [,� t �j Q US DO?Description(i udir� ProRer Ship n j 1Yy�N v �^gid ID b�)! � 1 12.Containers 13. Total 14. Unit ,r�-t� 1 � -!'- �(;f 1. `F Dpt� No. Type Quantity Wt/Vol I: Waste Number Z ° f�i'0,Asba54t}g,9,N 212i.�IiI. r;EER�'I7'I) � �" :� ..L I � State Hwy( G EPA/Other 7Er E a N N b. O State - °D ao E, R EP,A/Other c4v , A o State O ao O w R EPA/Other LU H d.. State Z r. U F EPA/Other W N J. A ditional Descripfons for Materials Listed Above _ K. Handling Codes for Wastes Listed Above Z "�] Ek,w3be$lm'S iitt ebfristvial(pipeln%_?�bon ,� O a. b. Z -15. Special Hondling Instructions and Additional Information t— EmerWcy Responce G ildeboa,..in v Wcfe, Wear apprrprate protective ClICA ng and resftalwry prcfssction!,'viler h and;ing. Z EMM3ENCY CONTACT: CHEMTRECPCCN: (860) 424-9300 Uj Slte'pi lc p a<ldress: 2800 S.CAUFORNIA ST STOCKTON CA 95206 Sob'# 9293 Q16. GENERATOR'S CERTIFICATION': I hereby declare that the contents of this consignment are f iy and accurately described above by propership ing'name and are classified,packed, ' U marked,and labeled,and are in all respect;in proper�rondition For transport by highway accgrding to applicable international and national government regulations. —J If'I am a:large quantity generator,1 certify that I have a'p'ro ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically Npracticable and that I have selected the practicable method of treatment,-storage,or disposal currently available to me which minimizes the present and Future threat to human;health and the environment;OR;if l am a small quantity generator,I have made a good faith effort to minimize my waste generation.and select the belt waste management method that is O available to me and that I can afford. Printer/Typed Name a � Signature *�a$" ,..- Month Day Year enz Wtt .! B; 17.`Trans orter 1 Ack owled ement of Receipt of Materials LU A Prin [Typed Name SignaYv Month Day Year wN �. . iF s ;p w - P J �f° 0.'.,..i d . 0 0. .18. Transporter 2 Acknowledgement of Rec i t oFMaterials T Pri d yped Niii Ea e f'� Si pature F � ✓'�� Morirh' Day Year . 77 U ;}Discrepancy Indication Space .,., F Z A C _ l 20. FacilityOw er or O e.ato rCert' cation ecei t of hoz rdous materials covered 6 thi maniF f exce/t as noter�in I.e '19 T ante /Typed me' ' - Signafur - / t, th'' a Ye _ Y DO NOT WRI `BELOW THIS-LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. DTSC.8022A(t/99) (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.)