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State of California—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9-30-99) See Instructions on back of a 6. Department of Toxic Substances Control <br />'Pledse prinF6�, cpe. Form designed for use on elite (12-pitch)lifer. M Sacramento, California <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) Yellow: GENERATOR RETAINS <br />EPA 8700-22 <br />1. enerator's US EPA ID No. Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />UNIFORM HAZARDOUS.r <br />; P <br />is not required by Federal law. <br />WASTE MANIFEST <br />of <br />ti t o <br />3. Generators Name and MaWingtAddgess r <br />A. State Manifest Document Number a�a <br />R , � ��'r� 4rty .•: <br />c <br />;oe<.Ae�'f <br />M1- �, <br />- <br />B. State Generator's ID <br />_ { <br />'�Z 1 <br />J <br />A. Generator's Phone L _ ;r ,r' <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter's ID [Reserved.] <br />l.v�+��*-'tTI_R F NVI�"ei�l"+MENTt" L a`-- <br />D. Transporter's Phone 15 1 <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID [Reserved.] <br />F. Transporter', Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. Stare Facility's ID s <br />'� <br />Alae/ISO IlvtiEPEN'3E'NT OIL <br />er� ,1 U f iLA 4A/ Vr4 <br />5002 ARCHER >TREE 9 <br />H. Facility's Phone <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />Quantity <br />14. Unit <br />Wt/vol <br />I. Waste Number <br />No. <br />Type <br />a <br />r r 4 1 NOR RGRA HAZARDOUS'WASTE, <br />9 ,.. <br />Stare <br />EPA /O <br />G <br />,�•� t�t� <br />11-1 I;.II�i <br />11 Ir <br />r .t <br />E <br />N <br />b. <br />,rare <br />E <br />EPA/Other <br />R <br />C. <br />State <br />T <br />O <br />EPA/Other <br />R <br />d. <br />State <br />EPA/Other <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Co4fes for Wastes <br />Listed Above <br />a. 1't` <br />b. <br />15 Special Handling Instructions and Additional Information <br />�^. <br />-.�'.•'1C.� <br />VV;:`AR PPE, L":MEPiS.iENCY €\It5K WAYHY'ARI-3 514-476-1740 ERG--- 9 �ti;j>�•� <br />f<..�; <br />16. GENERATOR's CERTIFICATION: I hereby declare that the contents 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 I am a large quantjy"generator, l 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 />Printed/Typed Name <br />Signature <br />Month Day Yean-r <br />� <br />f <br />T <br />17. Trans otter 1 Acknowledgement of Receipt of Materials <br />R <br />p <br />Is <br />Print ed/Tped Name <br />Signature .» -• <br />n Y ' <br />P <br />0 <br />18. Transporter 2 Acknowled ement of Receipt of Materials <br />R <br />T <br />Printed/TYP ed Name <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />_ <br />L <br />1 <br />20. Facility Owner or Operator Certificationof receipt of hazardous materials covered by this manifest except as noted in Item 19. <br />T <br />Printed/Typed .Name <br />Signature -' <br />Month Day Year <br />Y <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) Yellow: GENERATOR RETAINS <br />EPA 8700-22 <br />