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State of California—Environmental Protection Agency `y <br />Form Approved OMB No. 2050-0039 (Expires 9,-30.99) See Instruc}ions O(I backof e yw� Department of Toxic Substances Control <br />Please print or type. form designed for use on $life (12-pitch) dnk <br />S, ramento, California <br />T: eraror's US EPA ID No. amfesP Document No. 2. P..age I. Information in the shaded areas <br />UNIFORM HAZARDOUS <br />, <br />WASTE MANIFEST .. is required by Federal law. <br />IA IR if) 10 10 , Ct S 3 12 .. old <br />dress , <br />3. Generator's Name and Mailing Adgp <br />A. §tgfe iklcidtfeVE aeunent [*lumber A <br />24N 82- <br />LO`€. <br />P'.,MCKTON <br />d $w <br />C": owl <br />ESS <br />B: Stal6 Getleratar`s Ip <br />to <br />4. `e'nerators hone CID <br />2 %2­406U <br />N <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C, state Tror sporters ID [R sery d.j <br />h <br />OD <br />00 <br />�° NRI ERY1C , , <br />,l# Trrt �patfe�s Phone , <br />00 <br />7. Transporter <br />Trans orter 2 Company Name 8. US EPA ID Number <br />s tD (d_j <br />Q <br />... Transporw Py.0 <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State i ` 's <br />Q <br />PZ2MQ <br />O f ERD <br />H. Fast ttl a ne <br />� L � <br />p <br />J <br />Q <br />V <br />11. U$ DOT Description (including Proper Shipping Hyazardg Class, and IDgNumberl <br />12. Containers <br />13. Total <br />Quantity <br />14. Unit <br />Wt/vol <br />1. Waste Number <br />No. <br />Type <br />F <br />ppNl!aggma�gge, <br />a. -R J S � ar TF, MUD (OILY <br />tM <br />$tea - <br />?� <br />G <br />tT <br />T <br />0 <br />0A/tither <br />o <br />N <br />b. MIS WASTE STREAM HAS BEEN QUALIFIED00 <br />ate <br />00 <br />E <br />FOR RECYCLING/TREATMENT AT THE <br />�. <br />C14 <br />A <br />- <br />o <br />TIIVUUMrioly <br />` CALIFORNIA. THIS FACILITY HAS THE <br />State <br />00 <br />P <br />0 <br />R <br />R <br />NECESSARY <br />PERMITS TO RECEIVE YOUR fW1 ASTE <br />EPA/Other <br />LU <br />d. A BER IS TOBOO133 <br />State <br />Z <br />V <br />EFA/Cather <br />U.1 <br />�.^., <br />1 Addifianal Dascrlpfilenst'Mafaritr} kisfed A}sctve 7471 <br />iE. }rtatf ctits fear Wasfe� <br />Gisfai}'Aba've <br />CL <br />H <br />j <br />e'. <br />d. <br />Z <br />15. Special Handling Instructions and Additional Information <br />Q` <br />C6 r� I {s -. <br />E PP IE7 i t C"g CONT <br />Z <br />. <br />RAER04 11P, 171 <br />LU <br />+ t-1201FRIAW <br />- r. 1 <br />WEST VRCLE, STMKU OK CA oms.. ^ W S-1 <br />Vmarked, <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment a fully nd accuratelly.. described above by proper shipping name and are classified, packed, <br />and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br />C- <br />If I 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 />N <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 />the OR, if I I have made faith to best is <br />O <br />and environment; am a small quantity generator, a good effort minimize my waste generation and select the waste management method that <br />available to me and that I can afford. <br />V <br />Printed/Typed Name <br />Signature <br />A <br />Month Day_ Year <br />1011 01 <br />Z <br />_vb <br />w <br />R <br />17. Tcansporter 1_ Acknowledgement of Receipt of Materials a r > <br />'A <br />Prip ,Y Natpe } i <br />Signature a ; <br />Month Da Year <br />uy <br />P <br />V. <br />tL. <br />It <br />18. Trans orter 2 Acknowledgement of Receipt of Materials <br />0 <br />R <br />Printed/Type Name <br />Signature t <br />Month Day Year <br />LU <br />V) <br />E <br />R <br />C4j <br />19, Discrepancy Indication Space <br />Z_ <br />F <br />A <br />C <br />L <br />1 <br />2W Facility/Owner or Operatcn Certification ofireceipt of hazardous materials cov d this manifest except as noted in Item 19. <br />T <br />Y <br />.int /Ty ams ! <br />Si a <br />Month eay eeor <br />r <br />DO NOT WRf E BELOW THIS LINE. <br />.' Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />TSC 8022Ai1/99) (Generators who submit hazardous, waste for transport out-of-state, <br />PA 8700....-='12 produce completed copy of this copy and send to DTSC withir}=30 days.) <br />a <br />