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State of CFlifornia—Environmental Protection Agency <br /> Form Approved OMB No.2.050-0039(Expires 9-30.9 See Instructions on back of ---ie 6. Department of Toxic Substances Control <br /> Please print 4 type. Form designed for use on elite(I -pi/ch) <br /> iter. Sacramento,California <br /> UNIFORM HAZARDOUS 1. venerator's US EPA ID No. Manifest Document No. 2 Page 1 Information in the shaded areas <br /> WASTE MANIFEST �� 7 �j ' / - �� ? of is not required by Federal law, l' <br /> 3. Generator's Name and Mailing Address A, State Manifest Document Number <br /> ���? lnl. 11 „a�,� ��1�4$62 � <br /> O A y B. State Generator's ID I <br /> 4. Generator's PhontP ON6 06t+ 7 1�, ("a <br /> 11� k7 <br /> CN 5. Transporter 1 Company Na a 6. US EPA ID Number C. State Transporter's ID IReserved.) <br /> LOop <br /> t <br /> O D. Transporter's Phone <br /> Mfr. -rt;+�y Y"'/� f Y^i)• wrfi t�vr ��rr p <br /> O •.Vrt„.rar�.•!I tS efy.l«&–L.I rrYnJ lir I., •y .- '� •,' .i <br /> OP 7. Transporter 2 Company Na a 8. US EPA ID Number E. State Transporter's ID[Reserved.] <br /> QF. Transporter's Phone I <br /> U 9. Designated Facility Name and Site Addre 10. US EPA ID Number G. State Facility's ID } <br /> A-c f aUU6I WAL St.HilICL Ulf- 4U. INN P 4 fa 10 19 19 14 16 12 17 1 8 <br /> Z ii 700 ce• SIP7'rn 1•:T H. Facility's Phone <br /> 11. US DOT Description(including Proper Shi ping Name,Hazard Class,and ID Number) 1 12. Containers 13. Total 14. Unit <br /> Y1 U No. Type Quantity Wt/Vol I. Waste Number <br /> _Z a. State <br /> = KAOSI--RC:id fit+ 7Af r .)tJS WA8T*F t !+t 1,11r.) F <br /> r <br /> 3G �.!!!_. YdVIAT'E-11 f? EPA/Other <br /> E b. State <br /> o N <br /> 00D0 <br /> 00 E <br /> R EPA/Other <br /> A C. State <br /> o T <br /> 000 O <br /> R EPA/Olhar <br /> LU d. State <br /> Z <br /> LU <br /> U EPA/Other <br /> LU <br /> V) J. Additional Descriptions for Materials Listed A Bove K. Handling Codes for Wastes Listed Above <br /> Z <br /> 0" a. b. <br /> 0ILY WATCk t31 <br /> V) <br /> LU tt <br /> � f <br /> c. d. <br /> Q <br /> Z 15. Special Handling Instructions and Addition I Information <br /> 0 <br /> Q ! <br /> Z GI.,.fJVE5 <br /> Lu IwMURGE'NCY P1401417 1F. 2r 09-+E 67-6.1857 <br /> 16. GENERATOR'S CERTIFICATION: I hereby d eclare 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 respec s in proper condition for transport by highway according to applicable international and national government regulations. <br /> U <br /> If I am o 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 /> a practicable and that I have selected the pr cticable 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 /> available to me and that I can afford. <br /> OPrinted/Typed Name Signature „_ j Month Day pYear <br /> :Zj <br /> 19 <br /> u t T 17. Transporter 1 Acknowement of Recei t f Mater' Is I <br /> C� R <br /> LU B -Printed/Typed me �[/� Signature .. 7M ph D,Y ear <br /> w S �•� / V / 7 ( 1 <br /> k&r <br /> YL 018. Transporter 2 Acknowledgement of Receipt tf Materials �•"•f' <br /> G R Printed/Typed Name Signature �• Month Day Year <br /> w E i <br /> h R <br /> Q <br /> U F 19. Discrepancy Indication Space <br /> A <br /> L <br /> I 20. Facili Owner or O erator Certification of r cei t of hazardous materials covered b this manifest except as noted in Item 19. <br /> T Printed/Typed Noma Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. I' <br /> !f <br /> DTSC 8022A(1/99) Yellow: GENERATOR RETAINS 1. <br /> EPA 8700-22 <br /> L <br />