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State of California—Environmental Protection Agen y '.'--3 'jr:� •,•J;_ `��� <br /> Form Approved OMB No.2050-0039(Expires 9-3 -99) See Instructions on back OfP a9 e 6. <br /> type. Form designed for use on efit (12-pitch]typewriter. Department of Toxic Substances Control <br /> Sacramento,California <br /> UNIFORM HAZARDOU 1. Generator's US EPA ID Not. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> (,t +I �0.*_7,il)�}s_'?+i'Y._�.} i�{`.tG'. '( is not required by Federal law. <br /> WASTE MANIFEST of <br /> 3. Generator's Name a d Ma 1i.i Addr ss ~F'ct..1 f" _. J±�;.,_;,.,, A. State Manifest Document Number <br /> Bc1x 50 0M ��Ivsj00N 22884171 <br /> O .?�4�'•I tT AMON 4�A 9415E-2-0995 B. State Generator's ID <br /> � Ll..7 <br /> sr'1 44. Generator's Phone(+''09) ^-4LT].2•`• ' '.r*–' {/y <br /> T6P <br /> sN 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> °° ;�>a t T"'s' -l,LE1:}v SYS EMS, +.til_ P D000 5 O ;,0 � <br /> jO D. Transporter's Phone - <br /> c00 nrs esC1�.1 669—J.�f;•�� <br /> 7. Transporter 2 Company Name 8. US EPA ID Number <br /> — E. State Transporter's ID(Reserved.] <br /> u,v F . Transporters Phone ." . .. <br /> fe F I'ty an Sif ,A r�es(S�7t] �' t 10. US EPA ID Number G. State ocili IQ <br /> ';;:s ?:� SST#t STREE i <br /> 04 <br /> 00 <br /> O .-.RANENTO CA 95828 CA0000084517 H. Facility's Phone <br /> 9A6 '396-49143 <br /> cV VZQ . 12. Containers 13. Total 14. Unit11. US DOT Description fincludingProper SkippingName,Hazard Class,and ID Number) No. Type Quantity Wt/Vol <br /> f. Waste Number er <br /> lrZADR1ERS Wf `i . 4wID. I`J. 0. S. State <br /> y34_ <br /> 3 Ca r'fWJj D`JS BRr1I•ii `3CL_UT ICN(f-3. ;�#.'GAL} + EPA/Other <br /> c�i <br /> E r OSJ'39 <br /> O N b' State <br /> 00 <br /> 0000 E <br /> N R EPA/Other <br /> v A <br /> o T `' State <br /> a0o O <br /> R EPA/Other <br /> ae <br /> LU <br /> F_ d' State <br /> Z <br /> w <br /> U EPA/Other - <br /> w <br /> ZJ. Additional Descriptions For Materials List d Above K. Handling Codes For Wastes Listed Above <br /> Qa. b. _ <br /> d i <br /> Ln <br /> C. d. <br /> Q <br /> Z is ,d, ns a nd qd�d�t o all r on–r._ �"' � L i+..J!;-y- ,.!^L,• ,.�,+c:,,–;�.;, b'✓F ,,;1�'w.CO_,f ..:,' <br /> 11 2'AHR <br /> AILYfHORI ED TD RETAIN I_IzENS:Eri SUBSECK)E:i'dT ''t=11'Tr` T's*�P =17 1`4'ECESS.ARY <br /> Z <br /> LU A S;3t; rf s;: D <br /> "'ITE: r 3,10 E NII, SE, TCl>'„K T O'N <br /> � T'' fv t r;,• <br /> 16. GENERATOR'S CERTIFICATION: I here y declare that the contents of this consignment are Fully and accurately described above by proper shipping name and are classified,packed, <br /> Vmarked,and labeled,and are in all res ects in proper condition for transport by highway according to applicable international and national government regulations. <br /> I <br /> J i <br /> J If I am a large quantity generator,I Ice if/that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> Npracticable and that I have selected he her 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 II quantity generator,I have made a good faith effort to minimize my wa g neration and sel� best waste management method that is <br /> available to me and that I can afford. f j <br /> } Printed/Typed Nome _ Signature Month Day Year <br /> w T 17. Transporter 1 Acknowledgeri of Rece at of Materials <br /> W R <br /> p Printed/T ame Signature R g `/ �� Month Day Year <br /> LU <br /> i1ransporter2 Acknowledgement of Recei at of Materials <br /> O R Printed/Typed ed Name g Month Day Year <br /> T YP Si nature <br /> V)LU E <br /> Q R <br /> U F 19. Discrepancy Indication Space / Il <br /> Z A \ �� <br /> Facility Owner or Operator Certification 0 receipt of haze us materials covered 6v thi maniFest•ex t V­f..4 in It <br /> T Printed/Typed Name Si nature \ ' ( + <br /> 9 1 / Month Day Year <br /> DO NOT WRITE BELOW THI -TINE. '_ <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR W 309 . ED <br /> DTSC 8022A(1/99) (Generators who submit hazardous waste for transport out-of-state, <br /> EPA 8700-22 produce completed cod t hin 30 days.) <br /> R E VEi7 Ate 2 t'UDl <br />