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Slate of California—Environmental Protection Agen y -
<br /> Approved OMB No.? SL�-0039(Expires 9-3 -991 See II1SfCUCt10115 on bOC�C OF page 6.
<br /> Pa IS'rinf or type. Form designeordr use on elif (12-pitch)typewriter. P 9 Department of Toxic Substances Control
<br /> Sacramento,California
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<br /> vUNIFORM HAZAR�OU ocumen. Generator's US EPA ID No. Manifest Dt No. 2. Page 1 Information in the shaded areas
<br /> - is not required by Federal law.
<br /> WASTE MANIFEST of .. 1
<br /> 3. Generator's Name and Mailing Addr ss !_�'-.d P, •1• - ` A. State Manifest Document Number
<br /> B. State Generator's ID
<br /> Generator's Phone
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<br /> C'4
<br /> 5. Transporter 1 Company Name 6. US EPA ID Number C. State Tronsporter's ID[Reserved.]
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<br /> . Transporter's Phone n
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<br /> ' 7. Transporter 2 Company Name B. US EPA ID Number E. State Transporter's ID[Reserved.]
<br /> rQ _ .., _...,.., F. Transporter's Phone
<br /> U 9. Desi noterl,F%c i i o ear�d5'FteAd res;L.
<br /> 1 Q 9 C;.i�k O T .k 10. US EPA ID Number G. State Faulfy's ID y
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<br /> OMf .k :�l.i ,h „-;,j RE . . - H. Facility's Phone
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<br /> "Q Q 11. US DOT Description(including Proper hi m Name,Hazard Class,and ID Number] 12. Containers 13. Total 14. Unit
<br /> V P I 8 P pP 9 No. Type Quantity Wt/Vol I. Waste Number
<br /> IJ-+. - t�- .� k yT, _ State
<br /> �= 4 Ill:�,X.7i2 P ,!7 ., /
<br /> 3 G l-s..f�.E'1i�.Fh+�. r.,>.. , (17 ..�['I?+.',. ✓r / �p r 10,t EPA/Other
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<br /> EPA/OtherN
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<br /> U EPA/Other
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<br /> J. Additional Descriptions for Materials Lisfe Above - -
<br /> Z P K. Handling Codes For Wastes Listed Above
<br /> 0 a.y 6-
<br /> 1/5 -+. .3.4, --
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<br /> Z 15 Special Handling Instructions and Additi al InFormahon
<br /> 16. GENERATOR'S CERTIFICATION: 1 hereb declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed,
<br /> Q marked,and labeled,and are in all resp is 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 quantify generator,I certi that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economical)y
<br /> N practicable and that I have selected the p acticable method of 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 small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is
<br /> Oavailable to me and that I can pfFord. i y
<br /> U Printed•TyR6d Name,t4 Signature k, , 1�I'\ Month Day Year
<br /> w k 17._Tr6s,orter 1 Acknowledgement of li of Materials
<br /> .. .- ..R., frinfed/Tyf3CNamg,.._., _i.. - .. _.. ..�._.... .Sign_. y_ Month Day Year
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<br /> OB 18. Transporter 2 Acknowledgement of Recei f of Materials
<br /> R Printed/Typed Name Si nature
<br /> ts.t T g Month Day Year
<br /> N E
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<br /> U 19. Discrepancy Indication Space
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<br /> 1 20. FacilityOwner or Operator Certification of jeceipt of hazardous maferitAs-covered•b this manifest ex t as noted in Item 19. 1
<br /> Tt •Pripture ted/T ped Name Si na \
<br /> / ti ontb', Day: j Year.,
<br /> DO NOT WRITE BOLOW THIS LINE. �ti--
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<br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30•DAYS.
<br /> DTSC 8022A(1/99) (Generators who submit hazardous waste for transport out-of-state,
<br /> `- EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.)n
<br /> RECEIVED JAN - 61003 J JJ
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