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P <br />State *omia—Health and�Y etJar��lt�pncY t i.� '?i. i -'i �fl ] F� T. j�#?�d,' ��JF, <br />Form'i /feed QMB No. 2QSQ=- . (E'xpires 9"A0- t{ <br />r...,a rFnrm desinned ler use on elite oitch tvoewrifer). <br />Department of Health Servir <br />Toxic Substances Control Divi <br />Sacramento, Califor <br />DHS 8022 A (1 /88) ` Do Not Write Below This Line i <br />EPA 870D-22 <br />(Rev. 9-88) Previous editions are obsolete. <br />WHITE: TSDF RETAINS <br />' ;.. UNIFORM HAZARDOUS <br />Vrr <br />1- Generator's US EPA ID No. Manifest <br />Document No. <br />2. Page / <br />- <br />Information in the shaded areas <br />WASTE MANIFEST <br />i` -� !) (1 tJ r s, to % <br />of f <br />is not required by Federal Is <br />3. Generator's Name and Mailing Address 61'.i^2E Ai° 3 W` T'^F: <br />A. State Manifest Document Number <br />a"HEL,i, 0IL COMPANY. PG PFJ-,: <br />8 5 Y 015 <br />ANIMIETK. C.ii, 9,28103 ,: `. TRA; -'Y b -r ti. <br />_ <br />B- State Generators ID VLYC ir, 00. <br />4. Generator's Phone ( 14) F ^( ; y . Tj<AC . ,-r`i �' `• i <br />. HlYIH1013161- <br />5. Transporter 1 atpany Name 6- US EPA ID Number <br />C. State Transporter's ID <br />_ ` s" S <br />D. Transporter's Phone S <br />7Transporter 2 Company tipme 8. US EPA tO Number <br />E. State Transporter's 10 <br />1 , r i <br />fJ ` 1.1{ ^ <br />S <br />F. Transporter's Phone <br />t/ 1L (_ I \ r i � <br />9. Desi ated Facility Name and Site Address - 10. US EPA ID Number <br />G. State Facility's ID <br />Ei TCK-O(M, <br />8G G3 9� <br />K Facility's Phone <br />5 }[irI-sARR P"WLEVARD <br />255 <br />P117Eii3f10, CA 941 fij 3 ! 1! i) <br />P1171414010, <br />12. Containers <br />13- Total <br />14. <br />t- <br />11. US DOT Description (Including Proper Shipping Name, Hazard Class, and tD Number) <br />Quantity <br />Unit <br />Waste No. <br />No. <br />Type <br />Wt Vol <br />a• <br />State 51A - <br />G <br />E <br />i Sto-? RMPt y Undo? rgr"tt15 # : <br />