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Pleaseprint or type. form designed for use on elite 112•pitchj typewriter. Departmentof Toxic Substances Control <br /> Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Docu o. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST ® ® •7 0 ® ® f of <br /> 3. Generator's Name and Mailing Address Address� A State Manifest Document Number <br /> M4r;Hq <br /> 18 9 846.3- <br /> 0 <br /> rock k+.at CA q s'•a.19 B. State Generator's ID Y <br /> 4. Generator's Phone(.IZ-1 { <br /> P <br /> 5. Transporter/1rC�ompany Name 6. US EPA ID Number C. State Transporter's ID[Reserved.) <br /> �� , , D. Transporter's Phone <br /> O <br /> xxve <br /> CP 7. Transporter 2 Com an Name ' <br /> Pa P Y / 8. US EPA ID Number E. State Transporters ID[Reserved.) <br /> J F. Transporter's Phone <br /> Q <br /> V 9• �d�ocil' a SjAd Ops Ff 10. US EPA ID Number G. Stat ty's ID <br /> DO Z4��" <br /> 3si.sf al& Sky voic �. <br /> H. Facility's Phone <br /> 0 <br /> ad aA2X96 <br /> l <br /> Q 11. US DOT Description(including;,.per Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> V P f 9 P PP g No. Type Quantity Wt/Vol 1:Waste Number <br /> o. �0 J ti`CAL 7m State <br /> 3 G 50 `t Ga✓r jA,7,N4-TcJC hJ i CC Es ) EPA/Other <br /> E b <br /> 00 NH <br /> tate <br /> r <br /> N R EPA/Other <br /> v A C. <br /> o ,T <br /> State <br /> m ® <br /> R EPA/Other <br /> LU d, <br /> Z <br /> Z State ,. <br /> W ' <br /> U EPA/Other <br /> w <br /> ZN J. Additional Descriptions for Materi fisted Above _ K. Handling Codes for Wastes Listed Above. <br /> r <br /> w <br /> C. d, <br /> ® 15. Special Ho dling Ins ructions and Additional Information <br /> 'Z �� Rr E,�.��.NCr p�, -�s� c�+c �. ��c 8o0-- 14aN- g3®a <br /> LU <br /> 9 <br /> lua 16. GENERATO 'S CERTIFIC ere y declare t a e cont is of this consignment ore fully 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 /> —�' If f 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 /> practicable and that I have 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 made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> available to me and that I can afford. <br /> VP rated/Typed Name C Signature -- nth Year <br /> R 1 Trans iter 1 Acknowledgement of Receipt of Materials 4Z 1 <br /> A Printed/ me Signatur <br /> N / Month . .Aay Year <br /> w <br /> tA 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> < <br /> R Printed/Typed Name Signature Month Day YeE <br /> U F 19. Discrepancy Indication Space <br /> C <br /> C <br /> I <br /> L <br /> 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T <br /> VeqlTi [}peid/N <br /> Y _ay me Signature Month Da Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> ,DISC 8022A(1/99) _ „S ;Fi S „F, <br /> 7 TO DTSC WITHIN 30 DAYS. <br /> EPA 8700-22 3. G, So:ramento, CA 95812 <br />