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rarm Appravea Vivo No [wiP—WaV tcxPires z JV 7 7 r vi wxic auparam... <br /> Please print or type Harm designed for use on elite f 12 pitch)typewriter Sacramento California <br /> I UNIFORM HAZARDOUS 1 Generators US EPA ID No Manifest Document No 2 Pogo 1 Information to the shaded areas <br /> + ? is not required by Federal law <br /> WASTE MANIFEST161 of <br /> 3 Generator s Name and Mailing Address A State Manifest Document Number c C*� <br /> I r l-CI 111INIMA141 2026536JC <br /> r <br /> I re I ( I"Al II-I( AVC �­ O K I ON C.A 95201 B Slate Generator's ID r �.. <br /> f\ 4 Generators Phone ( )Ijt)) I(i,f 1I1(1t' r <br /> I +[V 5 Transporter 1 Company Name 6 US EPA 1D Number C State Transporters ID I Reserved <br /> W <br /> r D Tran:porter's Phone <br /> 7 Transporter 2 Company Norco 8 US EPA ID Number E State Transporter s ID jRese <br /> F Transporter's Phone <br /> (.1 9 Designated Facility Name and Site Address 10 US EPA ID Number G Sk to facility s ID <br /> AWAry <br /> 2430 z M]1 W-) 1111 H Facility's Phone �r <br /> 0 `=li del i� `it'IiiE ktrr NV 61),121,11 <br /> C=i12 Containers 13 Total 14 Unit <br /> 1 US DOT Description(including Proper Shipping Name Hazard Class and ID Number) No Type Quantity WI/Vol I Waste Number ) <br /> Z a WON Int $?A 11A,? I0100'_. WAI- 1 LIQUID State 721 <br /> z <br /> (00 & VIVA I I M EPA/Odser F,u <br /> 3c cman,6 <br /> E b State <br /> C11 N <br /> co E EPA/Other <br /> v R <br /> A c State s- <br /> _ ; <br /> 0 O EPA/Other <br /> R rti <br /> L; d score <br /> Lu EPA/Other <br /> V <br /> ssa <br /> N J Additional Descriptions for Materials listed Above K Handling Codes for Wastes Listed Above <br /> Z <br /> a b <br /> I ctlI P. t°JAII IS <br /> c d <br /> Q <br /> z 15 Special Handling Instructions and Additional Information <br /> O <br /> Q At'I'I W1'I?IA I I I'IW I I_I ]10 ( 1 01 11946 <br /> z i -Ail 11 At Ni s Citi 1 A I GIt)9)ft'+.IUj <br /> .J.+ 16 GENERATORS CERTIFICATION i hereby declare that the contents of this consignment are Full and accurately described above by proper shipping name and are classified packed <br /> marked and labeled and are in all respects in proper condition for transport by highway according to applicable international and nationa3 government regulat ons <br /> If I am a large quantity generator I certify 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 />' d praclica6le and that I have selected the racticable method of treatment storage or disposal currently available to me which minimizes the present and Future threat to human health <br /> vs <br /> and the environment OR if I am a sine I quantity generator 1 have mode a good forth off art to minimae my waste generation and select the best waste management method that is <br /> available to me and That I can afford <br /> OPrinted/Typgd Nomf Signature/ ; Month Day Your <br /> ]/+ t� ' 7 <br /> Z r ` , <br /> Lu T 17 Tran rfer Ackno,v ed ement of R ei T of Materials �'�~� <br /> Ce A Printed/Typed Name Signature �� Day Year <br /> Lu N <br /> z� <br /> u_ O 18 Transporter 2 Acknowled ertent o ecei fof Materials ', �• <br /> 0 Month Dar Year <br /> T ?riniaur.yPnsi isume e - <br /> +i+ E <br /> rn A <br /> U19 Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> 20 Facility Owner or O erator Certification of receipt of hazardous materials covered by this manifest exce t os noted M Item 19 <br /> T Printed yped Name Signature Month Day Year <br /> Y C' 4 17 1 G <br /> IDO NOT WRITE BELOW THIS LINE <br /> DTSC 8022A(1/991 Green TRANSPORTER RETAIN5 <br /> EPA 8700-22 <br />