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State of Cali a-Environmental Protection Age cy Form oved OMB No.2050-0039(Expires 9. 0-99) See Instructions on back of page b. Please print or type. Form designed For use an of to(12-pitch)typewriter. P 9 Department aF Toxic Substances Control Sacramento,California UNIFORM:HAZARDO S 1. Generator's US EPA ID No. Manifest Document No. 2. Page I Information in the shaded areas WASTE NIFEST `C A 1 `''�`'-�L`�'(�''�20 "4`+?99 w l is not required by Federal law. w of 3. Generator's Name and Mailin Ad ress [-fit, , i. O y[_f_ A. State Manifest Document Number ?s' �3>J?Ct1'i• f7L�7Lr! 3.EC5!_;f7tJ In CA 9>•I-r,,/'83 _)9,1� B.,State Generator's ID LO A. Generator's.Phone( 20'-.� 474-4014 s11� =-r•=3- s N 5. Transporter I Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] CN _ .� f ---K'L-E�N S,y TEM113s INN C 6 n 'ETY D. Transporter's Phone GOO 669-5740 CP 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] �J cy-,< '- F. Transporter's Phone ,R. Desi natal Facili ond, a =`�`-' "' 8 IY i dressy 10. US EPA ID Number G. State Facili!X's,ID (17Q :i•+.'r s; s\ Ci'a t' i l.r L.';: ..� - 4X '-i: , W/'y i''iTC i.,p c'`Js�3 �1:'.I J Q;JIj�"f'..'iry'�f 1 . H. Facility's Phone O 9....J I I I I I I I I I 1 171 r., ;`86-49 13 c.r,ou< 1 I. US DOT Description(including Prop r Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit No. Tye Quantity Wt/Vol I. Waste Number ��Z a. State D03-9)9) t i s 11"%t J 134 cr EPA/Other G 3 ilt iluECfI.Icc liH�`,IiE ON�F5, "S.-h-l6,i"L. � s�l?i�9 E o N 6. State co E V R EPA/Other CN A O T ` State - ado O R EPA/other d' State Z LU V. EPA/Other w rq. ._. .. .... ._ -Z 1. Additional Descriptions for Materials Li fedAbove - K. Handling.Codes For Wastes Listed Above 0 a. 6. N 34 LU - ac c. d. e ,,.. �pcl� Jew ! L)'lQ i i p nstF�t7777 '24-R14 SX AUTf-iOR I ZED TO R ETA.T N L-ICENSED SUBSEQUENT CA'r?R I LER IAt3 NEGE11E.3`��, 2'Y Z w A 839 B u 1 ..+00 E 6 MIL.E II? STOCKTON 16. GENERATOR's CERTIFICATION: I he by declare that the contents of this consignment are Fully and accurately described above by proper shipping name and are classified,packed, Vmarked,and labeled,and are in all r spects in proper condition For transport by highway according to applicable international and national government regulations. J .2 IF I am a large quantity generator,I certify that 1 have a proggram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economic 11 a- practicable and that I have selected practicable method aF 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 s all quantity generator,I have made a good Faith effort to minimize my waste generation and select the best waste management method that is O available to me and that I can afford. } Pripted/Typed Name p Signature Month Day Year Z U / w T 17. Trans iter 1 Acknowled ement of R ei t of Materials a' AR Printed ed Nama w R SignatureMonth Day Year Lu / ') ,) (� sa.. 1 18. Trans orter 2 Acknowled ement of Re int of Materials 0 R Printed/Typed Name Si i Month Day Year W T V) E Q R V 19. Discrepancy Indication Space Z P A C !� L \, 1 20. Facility Owner or Operator Certificatioa of receipt of hazardous nal,covered b "s m st exce t s n Fed in Item 19 j� -- T fyp`ed/Typed Name '1 . Signatyre �` - �Mor't�i D 1" ear r (� )L� -�; l - rvl ';IX)4 0.CT I1}>'M' c'� D NOT WRITE BELOW THIS LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WIT14IN 30 DAYS. `_.DTSC 8022A(1/991 (Generators who submit hazardous waste for transport out-oF-state, PA 8700-22 produce completed copy of this copy and send Yo DTSC within 30 days.)