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State of California—Environmental Protection Agency See Instructions on oacl, ul r" '�c: �• uepuiinwri�ui ��..�� - - - <br /> Form Approved OMB No.2050-0039(Expires 9-30-99 Sacramento,California <br /> Please print or type. Form designed For use on elite(12 pitch)f, ter. - 2 Pae 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS <br /> 1. Generator's US EPA ID No. Manifest Document No. 9 <br /> is not required by Federal law. <br /> Ft <br /> WASTE MANIFEST C:� A L 0'10 Cj (� (� `l y U O "L ( of <br /> A. State Manifest Document Number 2016 <br /> ���J 570� ^ <br /> U <br /> 3. Generator's Name and Mailing Address ,c y 57D ,,,{-„�A'o} �� N.� .NC A t <br /> s. r porgy - <br /> 1 �'��' �•0 3.. �y�� B. Slate Generator's ID � <br /> L, ej J `-A `7 5 <br /> 1 <br /> u7 A. Generator's Phone1J C I F/S-r bf 5 t <br /> rj 6. US EPA ID Number <br /> C. State Transporter's ID[Reserved.] <br /> CV 5. Transporter I Company Name Vll7k <br /> L (y1G^�'Vv L`iil e1o bi.-."'C ` f' D. Transporter's Phone <br /> Q J - a + J <br /> 7. Transporter 2 Company Name <br /> 8. U5 EPA ID Number E. State Transporter's ID[Reserved.] ! <br /> F. Transporter's Phone <br /> J <br /> .,�Qi 1 S EPA ID Number G. State Facility's ID 1 <br /> U 9. �s&jZtedj ygiILt%,N>gme 4'U'fA4(jA�l�re s1 ru�.� y(-rL',tAj <br /> iv� q <br /> [ N rt H. Facility's Phone <br /> �� ! A S k.v <br /> , o I- y I Fyuo - baa 3-5 /a 4y <br /> C , f1 `l L" A U C:s �a <br /> 12. Containers 13. Total 14. Unit <br /> Q and ID Number) Na Type Quantity Wt/Vol I. Waste Number <br /> �U 11. US DOT Description(including Proper Sh pping Name,Hazard Class, State <br /> _ f j( A-)- /?C rZ A 14 'Z A- EPA/Other <br /> o a <br /> 3 U � R� F>: N S i�1,.<+s� stare � e <br /> E I�1r�Si e �jul. �1 / 1 ` 4 <br /> o N b A f A Z nr�'J 3 t> PEPA/Other <br /> Co ® IVO N9- <br /> co E • /1 <br /> v R G ! S !�C .� s ., State f�j <br /> IqA C. n Y1 i1�-n L/�wf �n�7e �u 1• , 'rte 1O <br /> o T NO �� c ` EPA/Other <br /> o OD <br /> o L J\ D U3 � O 4)Ape <br /> r P I V N x5 Stare <br /> Zd. EPA/Other <br /> LU v <br /> K. Handling Codes For Wastes Listed Above <br /> J. Additional Descriptions for Materials Liste Above y d b. <br /> ' A, I I a. . I^ 636"1 <br /> V) IIb. � �` <br /> a34 C. d. <br /> Ile . F3(mb.5 <br /> a <br /> Z 15. Special Handling Instructions and Additi not Information -F� <br /> Q ('PE <br /> ,. lig,.. 7�.d <br /> LU <br /> M: ing name and are <br /> gaccurately p <br /> Q16. matrked,oOnd labeled,andTaOeNin a teres ectsclnrprohper condition t the tforf Ihanzpart by`h\ghway according toappli able international yand Hat onlal government egulatlionsfied,packed, <br /> U <br /> If I am a large quantity generator,I ce tify that have a pro ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be hum <br /> economical]yh <br /> n practicable and that I have ifsl lamed the Procticoby generator,oroyllhavle moderargood faith effort foosal rminimize'my wa a generation <br /> which <br /> onla d selenimizes ct ethe best wasresent te umanagement method that is <br /> N and the environment;O <br /> � available to me and that I con afford. Month Day Year <br /> 0 Signature./ <br /> d/T <br /> Pyn eyped Na <br /> Z <br /> w T 17. Trans orter 1 AcknowledV-ntRec i t of Materials 1 Month.., Day Year <br /> L7 R <br /> LU a <br /> A Printed Typed Name - 1 ti•' �l _ <br /> N <br /> w sC��� - <br /> P <br /> 18. Trans oder 2 Acknowledgement of Rec i r of Materials Month Day Year <br /> T Printed/Typed Name S n �o,� <br /> LU E <br /> N R <br /> U19. Discrepancy Indication Space <br /> F <br /> Z <br /> — A <br /> C <br /> I <br /> Month Day Year <br /> I 20. Facilir Owner or O erator Certificatio of receipt of hazardous materials covered <br /> b this manifest exce t as Holed in Item - <br /> T Printed/Typed Name <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow. GENERATOR RETAINS <br /> DTSC 8022A (1/99) <br /> EPA 8700-22 <br />