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State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-99) See InstTuctiafls On bac age 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(72-pt ewriter. Sacramento;California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST 0101# €) 0 .1 *3 1 1 ",f 1 9 of i <br /> 3. Generator's Nameand MailAddress A. State Manifest Document Number <br /> A L ,E ORN" CED <br /> Ift <br /> o37NXK11V141 CA 95201 <br /> B. State Generator's ID ! <br /> LOA. Generator's Phone( 209) —5,300 <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's IB Res ry -1 <br /> h <br /> 00 o Sk*01? DS SOLUTIONS C A 0 l� 0 � � ? D.Transporter's Phone <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID(Res rve A <br /> 00 <br /> Q F. Transporter's Phone <br /> V 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Fucifity's ID <br /> Q <br /> 21st " PitContury E141 <br /> 209b NEWUMS DR. E H. Facillty`s Phone" <br /> M0 rERNLEY, NV 69408 1 NJ V1 DI 91 81 01 51 91 51 31 21 3 <br /> J 7 <br /> 1 12. Containers 13. Total IA. Unit <br /> Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> V No. Type Quantity wt/vol i; Woos Number a ' <br /> Z <br /> a Q, WA*ta VIANWable li ui , U-0-0, ,• state , <br /> t= t�ki19 r IY (st dard volvt nt, rs <br /> ae <br /> 3 G G -1 DIM L 1°S fPA/O <br /> E <br /> ( CBixE" lhl3 # r ,400 <br /> dN b' t. Wass r 1 Ab,1e l i quid's, n 0 a., �« Stare � <br /> ao E (woly ntw, pain ) (D0 1,rG0 ) EPA} r' <br /> N R 0 �s 0 * D $ <br /> 6 A c, ABSINBENTS & OIL state <br /> w O I?—R S SOLT13 1.' <br /> R Ca Q1 k[ Sf la ERA/Ot r <br /> w d. State <br /> Z <br /> U EPA/Off er <br /> W <br /> N J.'Add'ti n I s ri do s for Materials Listed Above K. Handlfng Codes for Wastes Listed Above <br /> Z V 91701 b) Lt D 1` r ) L, c. b <br /> O <br /> N <br /> W <br /> c. d: <br /> J <br /> Z 15. Special Handling Instructions and Additional Information <br /> AP's FR -T w CL IING JOB SITE: 1340 W WASHItFdMN ST,, SqWXTON, CA <br /> Z "04ERGENCy &" ' `T : (6110) 746-7440" <br /> W SES E_R_ _ PAGE # 126 & 171 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name ond.are classified packed, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> If I am a large uantity 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 beeconomically <br /> ck- practicable andthat I hve selected 4he practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to�uman health <br /> H and the environment;OR,if 1 am a small quantity generator,I have made a good faith effort to minimize my waste genpfation and select the bast waste management method that is <br /> o: available to me and that I can afford. 3 <br /> O <br /> } Pr to d"/T/y�ped Name p $ Sign re ®` J / ? fylont a Qdy Year <br /> Z CZ LO l✓ t' t*, 111V G ✓ L 1 µ ,' CI <br /> W T 17. Transporter 1 Acknowledgement of Receipt of Materials / <br /> WA Printed/Ty_Vd Namep Signature Month Day Yea310 0 r <br /> W <br /> u_ 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> TPrinted/Typed Name Signature Month Day Year <br /> W E <br /> cn It <br /> raj 19. Discrepancy Indication Space <br /> Z F <br /> — A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or O erator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> v <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) <br /> EPA 8700-22 Yellow: GENERATOR RETAINS <br />