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State o` � �a—Environmental Protection Age .lit•-l� ' Fes—a"" 9Y Form Approved OMB No.2050-0039(Expires 9-31-99) .See Instructions on back of Page 6. Department of Toxic substances Control Please print or type. Form designed For use on eli (12-pitch)typewriter, - -. .. Sacramento,California UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Pa71information in the shaded areas CA L'_A8f jZA,M!r 4ci1 49:: � not required by Federal law. WASTE MANIFEST o erff5ijor s Ngtn$s� nd Mailings Add es J.i 1 1=L.j_ A. State Manifest Document Number' y -31E000NM 371532*911 SAN RV110N CA 94583-0995 B. State Generators ID h A. Generator's Phone(; 091 /y'',7 X4014 I,,,f ``' r�.11'� LT n CV 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transparter's ID[Reserved.] LO C? `,;�sl�E 1''—KLE E N SYS i EMS. I NIC T:�i Rt;`t7t?t>�r�?930 D. Transporters Phone so-D 669-5740 OP 7. Transporter 2 Company Nome , P P Y 8. US EPA ID Number E. State Transporter's ID[Reserved.] -' - .�c F. Transporters Phone r U Al r S]F4uI'ty ,and.,yt A r s 10. US EPA ID Number G. State Facili 's ID 1iVt _ ±_ 7 .''v.Y rJ J;t'FCi; Z{s,]'[, 4..$��.{1 Z t:::_T�: L, - `d' t?'' til i J�!(_jiy i,-h? �3 H. Facility's Phone 209 545-1011 r Q 11. US DOT Description(including Prope Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit 1 No. Type Quantity Wt Vol I. Waste Number = a. i`l-�:"n.1 !`}_....'!psi\I�,h,;C• tC0-jP0i{h!r':.. Sy. f�1 T - State .��:SL� `. ! t1 C3. �- !... a�_?l:� i f�•1.J'7 1.J"-�T.>iS i fJFi 1,-i�'c:�'rti f't�::t=t;i ); _ %�sjj' ['-/I � �.• EPA/Other 3 G il', .L21Ji_! 'r i d a i£ �i' CJ,_.t.;T.i.>JI` i s [ J .aft •'-s�_ o N 6. State oho E V R EPA/Other CN A o T C. stare m O R EPA/Other w d. State - r- Z LU U EPA/Other w Z7:Additional Descripti ns for Materials Lisl ed Above K. Handling Codes for Wastes Listed Above O 6. UJ .. .. Q ,�•e-4.iaL qy��{ `9g�Insf;;4ywapfi�qndA- -�p�al ln .- on 'T �.. ......� .'r'� -s�d• Z�,.."C4J._t .1�}.TzP 05't'Irs*GvisFY �iC' }63C3"_ '^7'7 ! S..s`{j:..Ij7 '_ F-• Q Z "' A 941. B :j 16. GENERATOR'S CERTIFICATION: I her y declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, < marked,and labeled,and are in all re pects in proper condition for transport by highway according to applicable international and national government regulations. If I am a large quantity generator,I c tify that I have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be economically hpracticable and that I hove selected thepracticable 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 I am a sm II quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is Qavailable to me and that I can afford. } Prir�lei{/Typed NameSign - .�.,- Month Day Year w T 17. Transporter 1 Acknowledgement of Rec i t of Materials LU A Printed ed Name w S Fj ��/1rQ 4R� t Signature Month Day._ Year P �..Jl OR 18. Transporter 2 Acknowledgement f Materials T Printed/Typed Name n e Month Day Year w E N R (aj 19. Discrepancy Indication Space, Z F — A C I L I 2Q,-fvcility Owner or Operator Certification r cei t of hazardous materials cov e by this manifest except a ted in Item 19. T ink T ed a Si n tutont Day Yea Y � 1 / � DO NOT WRITE BELOW THIS LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. DTSC 8022A(1/99) (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.)