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State of California—Environmental Protection Agency <br />Form Ayproved OMB No. 2050-0039 (Expires 9-30.99) See Instructions on back of name 6. Department of Toxic Substances Control <br />Please prirfiz:or#pe.. Form designed for use on elite (12 -pitch) ater. Sacramento, California <br />r. <br />H <br />3 <br />N <br />O <br />ao <br />OD <br />V <br />N <br />V <br />O <br />O <br />aD <br />LU <br />t— <br />Z <br />LU <br />U <br />LU <br />V) <br />Z <br />O <br />LUh <br />Q <br />Z <br />O <br />Q <br />Z <br />w� <br />H <br />Q <br />U <br />J <br />h <br />cleO <br />U <br />Z <br />w <br />ix <br />LULU <br />O <br />LU <br />N <br />Q <br />U <br />r4 <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99 <br />EPA 8700-22 ) YelIOW <br />: GENERA?OR RETAINc <br />> « <br />1. enerotor's US EPA ID No Manifest Document N16W. <br />2. Page 1 <br />Information in the shaded areas <br />UNIFORM HAZARDOUS <br />is not required by Federal law. <br />WASTE MANIFEST�i <br />m <br />o <br />of <br />3 Generators Name and Marling Address <br />A. State Manifest Document Number, <br />221308 <br />B. State Generator's ID <br />4. Generator's Phone <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter's ID [Reserved.] <br />,4_.-,A9"*t et$'4 PR EN RIf Wmi- s?- C t '; { vi !. <br />D. Transporter's Phone a 6.. „ <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID (Reserved.] <br />F. Transporter's Phone <br />9 Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />f'-tr.V&` iN fk PL".M)� `,N t,a` `., <br />�tf}`xg f��l, pit" V ,s <br />H. Facility's Phone <br />E S y'! f" k f, <br />k. �f ff <br />5ILTA8& P 40 <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />Quantity <br />14. UnitNo. <br />Wt/Vol <br />I. Waste Number <br />Type <br />a. ` - ..� _ <br />yy �,fitiS.�g ,ti. <br />'.,.. -:: .;r .fy� .`s - <br />_ <br />.. <br />_ <br />,. <br />.. ,. . <br />.. <br />State,„ -.,v7 ... <br />.-.� <br />j'>( -R a_�+ g. g ;(gyp �t <br />EPA/OX <br />G <br />11l 1si': <br />; t i `tt <br />`.„ .l t <br />'f <br />Nb. <br />State <br />E <br />R <br />EPA/Other <br />T <br />C. <br />State <br />0 <br />R <br />EPA/Other <br />d. <br />State <br />EPA/Other <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes for Wastes <br />Listed Above <br />1 1A <br />a. <br />b: <br />C. <br />d. <br />r'�.x! <br />15 Special Handling Instructions and Additional Information <br />a ��gg yr'�' ����qq ����gg {, �g pr,g (',$ p$r _t�'y� )p pg .ea y, gp _�7�..-- <br />'liNF R. �`f"E_� EeM9E"Y"�G+.'.9VCY �, f'.}F`�d�f A -C `K ORK "'"AYYBLARD 5..f0-4741^' ,M, E-Y"y t.9 <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and <br />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 <br />to applicable international and national government regulations. <br />If beam a large quant�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 Itve selected the practicable method of treatment,- storage, or disposal currently,avoilable to me which minimizes the present and future threat to human health <br />and the environment; OR, if I am a small,quontity generator, I have made a good faith effort to <br />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 />Signaturof <br />Month, ,,,IPay,Year <br />g <br />` <br />T _ <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />R <br />Ponied/Typed Name 'w " <br />S'gnature <br />`�`� <br />nth Day Year�r <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />R <br />T <br />Printed/Typed ed Name <br />YPY <br />Signature <br />Month Da Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />( <br />20. Facility Owner or'O erator Certification of receipt of hazardous materials covered by this ptanifest except as noted in Item 19. <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />Yl <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99 <br />EPA 8700-22 ) YelIOW <br />: GENERA?OR RETAINc <br />