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Apr 19 06 07: 43a DURRFLFIME WEST, 209 47823 p. 6 <br /> State of Calilomia—Environmental Protection Agency <br /> Farm Approved OMB No,2050-0039(Expires 9-30.991 See Instructions on back of page 6. Department of Toxic Substances Control <br /> Please print or typo, form designed for use on elite(12-pitch)typewriter. Sacramento,California <br /> 1, Generator's US EPA ID No. Manifest Document Na. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS; is not required by Federal law. <br /> WASTE MANIFEST T, ti ;+ f` r; ? i. of J_ <br /> 3. Genemtor's Nome and Mailing Address A. State Manifest Document Number <br /> 25107316 <br /> B. State Generator'stD <br /> uz <br /> tq 4. Generator's Phone( s i^t <br /> C 4 5. Transporter 1 Compony Name 6. US EPA ID Number C. State Transporters ID(Reserved.) <br /> O .�t ,`' - ��*...:",k-tr` ...ar.•:i•Tr;;i?.5�: fi rl li r; ti. t4 Lr .i D. 7ransporter'sPhonec;s' <br /> W 7. Transporter 2 Company Name 8_ US EPA ID Number E. State Transporter's ID(Reserved.) <br /> F_ Transporters Phone <br /> Q <br /> r)V 9. Designated Facility Nome and Site Address 10. US EPA 1D Number G. State Facility's ID <br /> �Q .�F'!y)-'-I•":.131..i i';r �_a,;!I:•rat;�'.. I:t._,. . <br /> H. FocililysPhone <br /> +. 0 'PLAN'FT.'-! <br /> 1L <br /> :3 12. Containers 13. Total 14. Unit <br /> V 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Numberl <br /> NJ No. Type Quantity Wt/Vol I. Waste Number <br /> State <br /> a' fa, f> a S1 _ !:<S i.:St __Arq'1 S.e d:. ( .:a. _: .I.:1 <br /> Pp OPP <br /> E b. State. <br /> co <br /> co Ij :l rf r rf. 1,. EP /Other <br /> R IWAA <br /> 1, <br /> cN <br /> R A c State �� <br /> o T <br /> m O EPA/Other <br /> R <br /> LU d. State <br /> snit EPA/Other <br /> V <br /> LU <br /> J. Additional Descriptions For Materials fisted Above K. Handling Codes for Wastes Listed Above <br /> W <br /> ac C. d. <br /> 4 <br /> Z IS.,dSpecial Handling Instructions and Additional Informatiop <br /> M ,.:T r 1 +i•'t' ) h: t L-`�. i.. .:= a ri_i <br /> Q i:S<fr l�1'1 sr?f�1 ffi <br /> Z <br /> tts <br /> F-- <br /> ..j 16. GENERATOR'S aRrIflCATION: 1 hereby declare that the contents of this consignment are fulty 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 national government regulations. <br /> V <br /> -+ IF 1 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 /> c practicable and that I hove selected the practicable 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 mode a good Foith effort to minimize my waste generation and select the best waste management method that is <br /> a available to me and that l can afford. <br /> OPrmted/Typed Name Signature Month Day Year <br /> y. <br /> U.) T 17,Transporter 1 Acknowledgement of Receipt of Materials <br /> LD R Month lm Year <br /> Si nature,! , d Y <br /> tA.t A Print /Typed Name g r <br /> Uj <br /> W O 18. Transporter 2 Acknowledgement of Receipt of Materials _ <br /> O R Printed/Typed Name Signature Month Day Year <br /> T <br /> Vl E <br /> d <br /> FA <br /> R <br /> V19. Discrepancy Indication Space <br /> 7- 20, facility Owner or ORSFolor Certification of receipt of hozordous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) Yollc:: El:"c f.A.TJR R::TAI,:S <br /> EPA 8700-22 <br />