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State of California—Environmental Protection Agenc
<br /> Form Approved OMB No.2050-0039(Expires 9-30 99) See Instructions on back r ge 6. a Department of Toxic Substances Control
<br /> Please prinf or type;'.Form designed for use on elite 12-pitc, miter. Sacramento,California
<br /> UNIFORM HAZARDOUS R� mo 'or's US EPA ID No. Manifest Document No. 2. Pa9el Information in the shaded areas
<br /> WASTE MANIFEfq Cj R 1 a is not required by Federal law.
<br /> 3 Generators Name and Mailing A e A. State Manifest Document Number
<br /> Y2002,-
<br /> ;yrs."y,1ro•.� B. State Generator's ID
<br /> honeR6EREY MSE
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<br /> sN 5. Transporter 1 Company.Name 6. US EPA ID Number C. State Transporter's ID[Reserved.]
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<br /> O !''..i� 'T7 -?, - ', =� ;. - D. Transporters.Phone
<br /> ;... 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.)
<br /> ' ka.J „.i_..?. '1' .tl _% .S'! �i�� ! ,s✓�/,rs.F. Transporters Phone
<br /> 9. Designated Facility Name and,$ite Address 1.0, US EPA ID Number G. State Facility's ID
<br /> '`+ a• 3 'r•==•- H. Facility's Phone -
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<br /> W .Y -.12. Containers 13. Total 14 •Unit•'
<br /> d qui V 11. US DOT Description(including Proper hipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol I. Waste Number
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<br /> 1> GE 3 _ EPA/Other
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<br /> tn J. Additional Descriptions for Materials List Above K. Handling Codes for Wastes Listed Above
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<br /> OZ 15. Special Handling Instructions and Additi nal Inf
<br /> ormation
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<br /> Q16. GENERATOR'S CERTIFICATION: I here declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed,
<br /> < marked,and labeled,and are in all res ects in proper'condition for transport by highway according to applicable international and national government regulations.
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<br /> -' If I am a large quantity generator,1 cer ify 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 /> hpracticable and that ftave selected the racticable 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 sma I quantity generator,I have mgde a good faith effort to minimize my waste generation and select the best waste management method that is
<br /> O available to me and that I can afford. 1¢�) r !r° �r d`A ,r ori!a -� F f� �y ,,Tl"'
<br /> Printed/Typed Name Signature✓y 9 J Month Day Year
<br /> Uni0 T 17. Transporter P Acknowled ement of Recet t of Materials --+
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<br /> ac p Printe>/Typed Name Signature j `
<br /> R r Month Day Year
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<br /> tL 0 18.^Trans orter 2 Acknowledgement of Recei t of Materials '
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<br /> Prinfea,�, ed Name �rti ; Month fay Year
<br /> T P tt �tl,� p Si�nafure
<br /> U 19. Discrepancy Indication Space s W r
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<br /> 20. Foci ity Owner or Operator Certification f receipt of hazardous materials covered by this manifest except as noted in Item 19.
<br /> j Printed/Typed Name Signature
<br /> Y fir. Month Day Year
<br /> DO NOT WRITE BELOW THIS LINE.
<br /> Yellow: TSDF SENDS.THIS COPY TO GENERATOR WITHIN 30 DAYS.
<br /> DTSC 8022A(1/99) (Generators who submit hazardous waste for transport out-of-state,
<br /> EPA 8700-22 produce completed copy of this copy and.send to DTSC within 30 days.)
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