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�__'ov-� lJf 1JLi ti � ._1 oA OMB No.2050-0039(Expires 9-30-9 I See Instructions on UUcn u y�p, Sacramento,California Plese print or type. Form designed for use on elite(I -pitch) 'iter. 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas UNIFORM HAZARDOUS is not required by Federal law. WASTE MANIFEST JA I L-1 010 lO Ci.161�51 y D b �' of p A. State Manifest Document Number 20169570 3. Generator's Name and Mailing Address /jr4y 5 r ONr A„��-,��.�•.V� _'��` -�y� •. J x••'11 c1 S X0 3 3 N B. State Generator's ID o �I $To L��•N J u7 4. Generator's Phone (ap�• 1 9 y� l+p r A-1 �kS (v it 5. Transporter 1 Company{Name k Q 6. US EPA ID Number C. Slate Transporter's ID[Reserved.] h co �"r�t..�5 P0 C-Tp'•T'LD►� � � � c D. Transporter's Phone �'00 -3ar 3D 0 S 'l O a? 8. US EPA ID Number E. State Transporter's ID[Reserved.] 7. Transporter 2 Company Name J F. Transporter's Phone QG. State Facility's ID nV 9 [0$li�>b�M.'Q Itty Nkme`rt' ,tp�Fl Ce$yy!K� (�(?1�1�IPJ EPA ID Number -4�Q j t=om L, .J Irl:1 S -c'r i k v 1; A P_ H. Facility's Phone �L-S 6i( �0 t+`l !e..nJ C;�-y A `1'313`1 C1 A 1r 70 1O 10 � � I .�J 12. Containers 13. Total 14. Unit 0a 11. US DOT Description(including Proper Shi ping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol 1. Waste Number V Slate w5TC $al. IS'I. �_ a ND A.�' 2 C 2 A 14 2+�^ D'<f .tEPA/Other 3 G 1 � g,,f'F: � S f1(� o 0 o NONe (� Slate )p o N b G r2 A �1 Zarfl v S kl S T oo E Nb O _ EPA/Other R j � i s� des G 3 pa o NoN� v A S� State p o T c /Z C 2 /t'6'T c Su (: p NoN OOJ O /� pp h �p f EPA/Others 1 R I 1 cel < ^ .r eA;^r.S s iJ [�\ j 3 0 State cle d. LU Z EPA/011ier W V J. Additional Descriptions for Materials Listed have K. Handling Codes for Wastes Listed Above tr IIQ . E ts3b+y b. V) It6. c. d. ttc . �831-163 a Z I 15. Special Handling Instructions and Additio I Information Z 6a �D'o 1.t �4— rj 3 o a t- 1 16. GENERATOR'S CERTIFICATION: I hereby eclare that the contents of this consignment are fully and accurately described above by proper shipping name and are tiostified,pocked, Q marked,and labeled,and are in all respe is in proper condition for transport by highway according to applicable international and national government regulations. V If I am a large quantity generator,I cert{ that I have a progrll am in place to reduce the volume and toxicity of waste generated to the degree I have determined to to economicaIt a practicable2and)hal I have selected the 1r cticable 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 small uontity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is LO ce available to me and that I can afford. Q ••�, Month Day Year ed,/jT ed Na e Signalur / -y O Z w T 17. Transporter 1 Acknowled ement of Recei t of Materials R S cLWre c�j 7onl t Day Year °C q Printe�(Typod Name - ) �'- LU P1 w 0 18. Transporter 2 Acknowled ement of Recei I of Materials Month Day Year R Printed/Typed Name natur 7 w E N R V19. Discrepancy Indication Space F Z — q C I L I 20. Facility Owner or Operator Certification of ecei t of hazardous materials covered by this manifest exce I as noted in Item 19. Month Day Year T Printed/Typed Name Signature ,,,, Y DO NOT WRITE BELOW THIS LINE. Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. DTSC 8022A (1/991 To: P.O. Box 400, Sacramento, CA 95812-0400 EPA 3700-22 02 3