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State of California—Environmental Protection Agency <br /> Form Aprroved,-.6MB No.;.00-0039(Expires 9-30-94) -See Instructions on bacSacraa k ge 6,..,y <br /> Please pn.A or type. Form designed For use on elite(12-pit writer. Department Toxic Substances Contr <br /> ' mento,California <br /> UNIFORM HAZARDOUS - Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WAS'T'E MANIFEST is not required by Federal law. <br /> of 1 <br /> 3. Generator's Name and Mailing Address <br /> LONMr48 Llv°e OJ <br /> Laboratory, S€te 344 <br /> C, PO BOX 808, L-820s Uvermom,CA 94531 <br /> in4. Generator's Phone ( ) <br /> 0 5. Transporter I Company Name 6. US EPA ID Number <br /> 00 Evergreen EnvkvmwntW Services <br /> _1 If-1A InIS1.81 016191 Fj 71 ill <br /> Q7. Transporter 2 Company Name 8. US EPA ID Number } <br /> U <br /> V)Z 9, Designated Facility Name and Site Address 10. US EPA ID Number <br /> W Evwgree 1 ON,Ine <br /> )00 6WO Smith Avemie <br /> NOW1111 k,CA 94560 <br /> WWv ICIA D t3 8 Q 8 8 7 4 1 8 <br /> tion 11. US DOT Description(including 12. Containers 13. <br /> p ( 9 Pro per Shipping Name,Hazard Class,and ID Number) Total 14. UnitNo. Type ntity Wt/Vol <br /> G Cornbustble t.igitid n.o s.,NA1993, til <br /> c.i E (diesel fuel) AOT01011 T <br /> 0 <br /> co tV b.co , <br /> 4 E <br /> R <br /> o A <br /> O j C. <br /> M <br /> RUj <br /> $t <br /> PA <br /> Z d. a - <br /> Uate <br /> w <br /> Z <br /> Add �. <br /> �1. <br /> P ,(rya <br /> W <br /> Z <br /> Q 15. Special Handling Instructions and Additional Information <br /> Z Wear ProteWve Clothing When Hartong. EMERGENCY CONTACT: M.N. Hayes, t510j 447-6880 <br /> W LLNL ShipDoc Number. S- Reference Release Number IWY- ®S ya on the 1tvoioe. <br /> These materials are NOT radloaedvely contaminated. <br /> 16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> Upacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international laws. <br /> JIf I am a large quantity generator, I certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be <br /> economically practicable and that 1 have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> N threat to human health 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 <br /> waste management method that is available to me and that 1 can afford. <br /> 0 Printed/Typed Nome Signature Month Day Year <br /> Vtfl <br /> T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> Lu 0 N Printed/Typed Name Signature Month Day Year <br /> w r / Y s�r.T.___.. <br /> wo 1 Transporter 2 Acknowledgement of Receipt of Materials <br /> Printed/Typed Name Signature Month Day Year <br /> O a <br /> W 19. Discrepancy Indication Space <br /> N <br /> V F <br /> A <br /> Z C <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest exc a ted it(Rem 19. <br /> TV Printed/Typed Name Signature nth Day Year <br /> /e—ZJ- — - <br /> DO NOT WRITE BELOW"THIS UNE. _ <br /> Vk Ar <br /> is Vr <br /> ,l CS _.�'S COPY GENERATOR, WITHIN 3G D.AYS. <br /> DTSC 8022A (12/91) t i6ererorors wi:o sub azordous waste for transport out-of-state, <br /> EPA 8700,-22 proiuce complete opy of this cooy and send to DTSC within 30 days.) <br />