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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 e 6. Department of Toxic Substances Control <br />"Please prir&.-�_ Pitch iter. Sacramento, California <br />,pope, Form designed for use on elite (12- Or <br />2 <br />Ck <br />C <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />Yello- GENERATOR RE-1A!N_-- <br />71 <br />UNIFORM HAZARDOUS <br />1.'Uenerator's US EPA ID No. Manifest Document NW.W' <br />2. Page I <br />Information in the shaded areas <br />WASTE MANIFEST <br />of <br />� <br />is not required by Federal low. <br />3. Generator's Name and.ng Address' <br />M <br />A. State Manifest Document Number <br />L"; 4 7� <br />1 27q36 <br />B. State Generator's ID <br />> <br />A. Generator's Phone] <br />-4- <br />4 <br />5. Transporter I Company Name 6. US EPA ID Number <br />C. State Transporter's ID [Reserved.] <br />D.Transporter's Phone V510147 -.41746, <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID [Reserved.] <br />I I I I I I I I I I 1 <br />F. Transporter's Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State Focilif <br />,y's JD <br />1,66 <br />H. Facility's Phone <br /><,ki V I Y') <br />j510)J7&,1740 <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />14 Unit <br />No. <br />Type <br />Quantity <br />Wt/Vol <br />1. Waste Number <br />StaW <br />k' -ARP <br />G <br />r 11"'EPA <br />�j <br />E <br />N <br />b. <br />State <br />E <br />EPA/Other <br />R <br />A <br />T <br />C. <br />State <br />0 <br />EPA/Other <br />R <br />d. <br />State <br />EPA/Other <br />J. Additional Descriptions for Materials Listedi Above <br />K. Handling Codes for Wastes <br />Listed Above <br />a. <br />b. <br />C. <br />d. <br />4, <br />15. S ial Handlin Instructions and Additional information <br />/47 <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper ,hipping 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 (am a large quant{ generatork I <br />, certify that I have a proyrarrf in place twreduce the volume and toxicity of waste generated to the degree I have determined to be economically <br />that <br />t ITave the treatment, disposal to future human healt <br />practicable and selected racticable method a storage, or currently available me which minimizes the present and threat to <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 ton afford. <br />ped Name i <br />Signature <br />onth- <br />MDay <br />T <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />A <br />2 <br />Printed d <br />�ome <br />_7 <br />Sig/na!yr <br />Month Ray yecui�, <br />N <br />$ P <br />1 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />R <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />L <br />20. Facility wrier orOperator Certification of receipt of hazardous materials covered by this m nifeit except as noted in Item 19. <br />T <br />Printed/Typed Name <br />Signaturg.. <br />Month Day Year, <br />y <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />Yello- GENERATOR RE-1A!N_-- <br />