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State of California—Environmental Protection Agen <br /> Form Approved OMB No.2050-0039(Expires 9-30 99) See Instructions on back of page a. Department of Toxic Substances Control <br /> Please print or type. Form designed for we on @file 12-pitch/typewriter. Sacramento,California <br /> UNIFORM NAZARDOU3 1. Generator's US EPA ID No. Manifest Document No. 2. Pogo 1 Informotion in the shaded areas <br /> is not required by Federol law. <br /> WASTE MANIFEST Al2 11ol I I of ) <br /> 3. Generator's Name and Mailing Addreis $tots Manifest Document Number <br /> PACIFIC BELL/sec 24106428 <br /> C:) QQ III VCV.% n MW B. Stats Generators ID <br /> In <br /> v7 4.S11{,�pt,Cr�94393 1 <br /> n <br /> h5. Transporter 1 Company a PA ID Number C. Stab Transporler's ID[Reserved.) <br /> ao <br /> O FIIC EIMIRGHWAL TMI. �. Transporhr'i!Mone <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Tromporhr's ID Re .) <br /> ^ J <br /> `V' Q F. Transporter's Phone <br /> ,t V 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> Q I C1 A d III III III ` 4 � 4 ' <br /> 5 17 <br /> Ce RNIC MI�TU. Tlla! H. Faciliy&Phone LII <br /> .4 0 2*1 BAT ROD I C1 AlD (M324-1631 <br /> 9W MCI it J Q Ca' -316MV-0 12. Containers 13. Total 14. Unit <br /> V 11. US DOT Description(includiag Proper hipping Name,Hazard Class,and ID Number( No Type Quantity Wt/Vol 1, Wash Number <br /> a. IM-KalA7ARMIS 1A LIQUID Slope <br /> 3 G IOIL,GRS1.tk') EPA/Other <br /> o N b. blots <br /> co E <br /> V R EPA/Other <br /> v A <br /> cr T C. Smte <br /> aao O <br /> R EPA/016r <br /> rY <br /> wd. <br /> � $Iola <br /> Zu.� <br /> U EPA/Other <br /> LLS LL <br /> LI) <br /> Z l.Ad�itiosal-0eecriptiwy ter McM+sle List Id Abos+ .. _._ ••- K. Ha ng�o�is-oar VJashs Listed Above <br /> Z <br /> O a. b. <br /> d <br /> V) <br /> cle <br /> Q <br /> Z 15. Special Handling Instructions and Additional Information <br /> ° 24 IQ. ENDO ICT Is (2119)474-4122 <br /> a SITE: 2311 E. EI(8T BILE tw'STDCIIm 9S21B <br /> Z <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment ars fully and accurately described above by proper shipping name and are classified,packed, <br /> Umarked,and labeled,and are in off respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> If I am a large quantity generator,I ca k fy that I have o program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economicolly <br /> Npracticable and that I have selected the actiCoble method o treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> and the environment;OR,if I am a sma�l inliy,generator,I have mode a good faith effort to minimize my wash generation and select the best waste management method that is <br /> ac available to me and that I can offord. <br /> O <br /> UYrinred/TYped ams r' �,J 7/ $i Month Day Year <br /> Z %. 71 ,014 <br /> w T <br /> O R 17.4"r Ap6rier 1 cknowl ent of Race t of Materials <br /> w f, Printed/Typed Nome Signature i� Month DAY Year <br /> LU PM i44 L T-� <br /> 0 o runs er 2 Ac now •t c stem t of Materials <br /> iPrinted/Typed Name Signature Month Day Year <br /> w E <br /> N e <br /> Q <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> — A <br /> C <br /> I <br /> L <br /> f 20. Facility-Owner or Operator Certification f receipt of hazardous materials covered b th s manifest except as n in Item 19. <br /> Y Printed/ Name Signature Month Day Year <br /> u <br /> btr'8k�rr: E DO NOT WRI E BEL6W THIS LINE. <br /> t Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC B022A(1/99) 1 (Generators who submit hazardous waste for transport out-of-slate, <br /> EPA 87DO-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />