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)tate of Cali torma—tnvlronmental erotectlon Age cy <br /> Form Approve MB No.2050-0039(Expires 9- 0-99) See Instructions on back of Page 6. Department of Toxic Substances Control <br /> Please pri r I pe. Form designed for use on eh a(12-pitch)typewriter. Sacramento,California <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOU i" :- is not required b Federal law. <br /> WASTE MANIFEST t� �' ' r3 -� .-. G [ x- % of q r <br /> ..� <br /> 3. Generator's Name and Mailing Ad es A. State Manifest Document Number pf <br /> 394856 <br /> O - - - - y r,.5 B.State Generator's ID <br /> >.< . Hca„�iiy:�; i ;�zl:;: >s ti San arrtar; d ,u .mi.�71, <br /> nA. Generators Phone( ) __ _ - - _ <br /> N 5. Transporter I Company fame 6. US EPA ID Number C. State l:r ns ort,r'§I es rve .) <br /> LO <br /> CP <br /> pD. Transporter's Phone - <br /> O 'ti{ ifiuY ik ,.s+ lar ,Etc w Z. t^ n •. <br /> ,jjQj2jr <br /> :Z q » <br /> op 7. Transporter 2 Company Name `9. US EP I Number E. State Transporter's ID[Reserved.) - �• <br /> J <br /> � Z Q ' F. Transporter'!Phone - _ <br /> .._...._-I _.. <br /> rLo V 9. Designated Facility Name and Site A dress 10. US EPA ID Number G. State Facility's ID <br /> Q <br /> 00 <br /> Z .i i�ii:iCe'.ci i�.ui . vii•+:i on..�.. <br /> oC H. Facility's Phone <br /> a p wwi May'nob*G <br /> ,�wpptt,. LL - <br /> 'k•.' Q I V +rntainers 13. Total 14. Unit` a•+r•,k `�' - <br /> 1 1. US DOT Description(including Prope Shipping Name,Hazard Class,and ID Number) <br /> No. Type Quantity Wt/Vol I. Waste Number <br /> State <br /> G v 9'"Y'vkC'•C'.-i'S'Cl�4r cS �' Cd„'S"'Iti k'rS'.. :wt,. i`w ts� a Ef" ...r EPA`Mther <br /> N E <br /> N �!tfis '�`✓�9�T .�}a C,r��'��� Mi;.xr 3 11/V}9�.5 <br /> StoT <br /> 00 E <br /> _ l} / 7 <br /> -V R °{^/�'f� it �r��` J QV� '" .�_ ^ EPA/Other ry <br /> o T C. <br /> State <br /> a0° O <br /> R EPA/Other <br /> ce <br /> tw- d. State <br /> Z <br /> w <br /> V EPA/Other: <br /> w <br /> J. Additional Descriptions for Materials Lisfed Above K. Handling Codes for Wastes"Listed Above <br /> �"� <br /> a. st b. <br /> �r- - - <br /> 11;J.Profile P'1id1IL'�'( ,ry �� �>�_. f <br /> { u7 <br /> w <br /> ae C. d. <br /> Q <br /> Z 15. Special Handling Instructions and Addt ional Information <br /> ia s�s +1AQ L4Z :EF �ea'ytl8r 14.an. f9ang <br /> w How ala e,clencv teleAlone- rtuti1be 1-916-977-7777 i Padfic Belli ER13: 128 <br /> � r-:..^•v �te,1.�Z"T.�r"`7 s1 n y :�., _:.a� --� ,Cr,,._-r' _, ,.c'X, -->;_ .i" �-; ! .<� <br /> 16. GENERATOR'S CERTIFICATICIR.' ery dec are t}tut-the c'o4.4s of this consignment are fully and accurately described above by proper' <br /> hipping name and-are classified,packed, <br /> Vmarked,and labeled,and are in all re pects in proper condition for transport by highway according to applicable international and national government regulations. <br /> If 1 am a large quantity generator,I c lily that I have a pro ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> C- practicable and that 1 have selected th racticable 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 sm I quantity generator,I have made a good Faith effort tardinimize my waste generation and selec�the best waste management method that is <br /> Oavailable to me and that I can afford. 1 i ` f <br /> >- Printed/Typed Name <br /> [Signature t Month Day Year <br /> LU 1 17. Transporter 1 Acknowledgement of ReC i t of Materials <br /> R <br /> oe A Printed/Typed Nome _ Signature Month Day Year <br /> LU <br /> P '7L"' �ivr"i� .'�. jr <br /> w <br /> 018. Transporter 2 Acknowledgement of Rec ptofMaterials I <br /> O R Printed/Typed Nome Signature Month Day Year <br /> w E <br /> Q R <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> — A <br /> C <br /> L <br /> 1 20. Facility Owner or Operator Certification f receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature ,.,�.- ---_'y Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> OYe�llow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A(1/99) RECEIVED JAN produce(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 0 a <br />