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Stale ofs,Colifornia—Environmental Protection Agen y .... ,..; Forz—., ed OMB No.2050-0039(Expires 9-3 -99) See Instructions o(1 bac(of Page 6. Deportment of Toxic Substances Control Please print or type. Form designed for use on elit (12-pitch)typewriter. Sacramento,California UNIFORM HAZARDOU 1. Generotor s US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas WASTE MANIFEST `h l is not required by Federal low. of 0 3. Generator's Name and Mailing Add ss �•./�irrJ sr�-•]}S�.r{{ S F. �.';e;....,._ A. State Manifest Document Number q�� `��. ("� �5.3t.J3`.{ i r��7, .J'a O (,�r.:.�34;i ihl _ r,A Q;, ';.8j 7,- :�1•, B. State Generator's ID LO 4..Generator's Phone(cr{..5 #) 47' I.. :.i.`,., tt `•� '.0 I'•;�'."..11 :I �]`9 N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] D. Transporter's Phone C*%]^ 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] WJ � _ _- � F.-Transporter's Phone-- '- < _._ _ ®V 9 Designated Facllity.Name and Stte A ress 1`! t•' 10. US EPA ID Number G. State Facility's IID �Q ll ))i._ (Lr C i•t S a I".:IyI.L.1! A.�Il• i :)F f\.l_l�.•..�� 1�3 "gar— N '(• -r H. Facility's Phone LOO tK'v (, t '7,.1•..:i{.s.Jr I'.!{1;,1 A 11. US DOT Description(including Prope Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit V No. Tye Quantity Wt/Vol I. Waste Number Z a. q 1. State hl, -'.j. J. — i til t"j, UE' '',01 LD £.[ 1' R 1.ATEE, 1 3 Ca (55 , `s 'j.�r~ t,+;5 wI'Io-' i )'1 7yA J EPA/Other l.r.��,.... .7 .. I"(••l. '.i'- .. .1 t-... 1 F. �.IiW; AIL..'' ��.0� �r 1 U E ••' � r1 o N b. State co E v R EPA/Other CN A o T c. State O R EPA/Other ce Lu d. State H Z w V EPA/Other Lu to J. Additional Descriptions for Materials Lis d Above . K. Handling Codes for Wastes Listed Above 1 Z O ? o. b. W d. Q 15 Special 0q dling lnstryctions and Addi ional Information �+ .. .,. Y,..1 t{.,"•, a,)✓'`�I'' �ht, t�j_.i.: r T--•';. Q Z W — �- 16. GENERATOR's CERTIFICATION: I here 6y 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 re pacts in proper condition for transport by highway according to applicable international and notional government regulations. -s If I am a large quantity generator,I c rtify 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 a practicable and that I have selected th racticable method of 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 sm I quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is a available to me and that I can afford. O } Printed/Typetd Name - Signature Month', Day Year_-r 1 T 17. Transporter 1 Acknowledgement of Rec i t of Materials' �- R Lu A Plrted/Type�t arae ; i� 1 Signature — —" --- Month.-,' Day Year— ! Lu LL. p 18. Transporter 2 Acknowled ement of Rec i 1 of Materials O T Printed/Typed Name Signature Month Day Year Lu E h R (Qj 19. Discrepancy Indication Space Z F — A C I L i�I 1 20. Facility Owne-r-or Operator Certification of recei t of hazardous materials covered b this monifesYexce t as noted,in Item 19. T Printed/Typed Name ( ( Signature J //'�� Mo Day Year .i LAIA Ili DO NOT WRITE BELOW THIS LINE. Yellow: TSDF SENDS THI5 COPY TO GENERATOR WITHIN 30 DAYS. DTSC 8022A(1/99) (Generators who submit hazardous waste for transport out-of-state, EPA 8700-22 produce completed of t o $_'DTSC within 30 days.)