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Form approved OMB No 20'5'0'-0,03-9(Expires 9 30 91) Toxic Substances Control Division Please print or type (Form designed for use on elite(12 pitch typewriter) Sacramento California UNIFORM HAZARDOUS 1 1 Generators US EPA ID No Manifest 2 Page t Information in the shaded areas � Document No WASTE MANIFEST A I(' 1 I^ n (` G p of , is not required by Federal law f 3 Generator s Name and Mailing AQdress A State Manifest Document Number L.P� M '3. C7:C Tr_,1%::ir fj'r � 7i iS r Ceti B State Generator's ID l A Generator s Phone( S'_E) 27^_x:j? C_616 I F 5 Transporter 1 Company Name 8 US EPA ID Number - C State Transporters IDLO t Q 4 a Q D Transporters s Phone N _ : �:.�'�::� sem _: c, �I n I s,�, r b, , 9, p 805 7,80-:-�270 in 7 Transporter 2 Company Name a US EPA ID Number E State Transporter'$lD 07 d I I I I I F Transporter.Phone m 9 Designated Facility Name and Site Address 10 US EPA ID Number G State Facility s ID C"i c4i Tiazt `.�1�a✓ :��, Inc./K:.,-.r ar _ Fails Feac. C A T ID 0101614, 6 i 3 7 IOv _ )y Cl, S*iil izc R(vad H Facility s Phone ,-,:5 Kee" !�_,Clty, CA 922:9 C I a r 0 010 614 6 1 17 (2439) -86-9711 12 Containers 13 Total 14 I �LL 1 1 US DOT Description(Including Proper Shipping Name Hazard Class and ID Number) Quantity Unit Waste No LO J No Type Wt/Vol a Haz.-rdcuz ;T1aStc S07.1u N'08./0R1-E/ State LO? G MO=89EPAJOther CC� N i V' CO3 E b State a A 0A CID T EPA10ther O v R G State m EPA!Ostler cc LU d State H - Z w 0 EPA!Other Uj Z J Additional Descriptions for Materials Listed Above K Handling Codes for Wastes Listed Above a.) Sail ccn..ainin pest1Cidesr DIT, r a b c d z 0 1= 15 Special Handling Instructions and Additional Information z a.) Prop 13? w S 0--J 26270 �� N V (Z 9 a 7 rRear ay.7,r ria -_ Lprctac:+ive C10Vi_1iQ and respi-ratcr wfttleen handlirj Q 18 U Tj GENERATOR'S CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified packed marked and labeled and are in all respects in proper condition for transport by highway according to applicable international and Nnational goverrimant regulations If 1 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 0 to be economically practicable and that I have selected the practicable method of treatment storage or disposal eurrentty available to me which minimizes the Y present and luture threat to human health and the environment OR if I am a small quantity generator I have made a good faith effort to min1ml2e my waste U generation and select the best waste management method that is available to me and that I can afford Z P•altedITyped Name CAT=- WHIMIORTH AS Signatur , Month Day Year w T;RliS E 11BAN MPTCY) FOR Cad.—FSS S n 5 1 P 1 �{ O <y T 17 Transporter 1 Acknowledgement of Receipt of Materials R A Printf ,d/Typed Name D Sigoature Month Day Year OS I7 , // f t / W 0 18 Transporter 2 Acknowledgement of Receipt of Materials UR Printed/Typed Name Signature Month Day Year E Z R 19 Discrepancy Indication Space F A C I • L 1 20 Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in item 19 T y Printed/Typed Name Signature Month Day Year DHS 8022 A(I 188) Do Piot Write Below This time EPA 8700-22 (Rev 9 88)Previous editions are obsolete Blue GENERATOR SENDS THIS COPY TO DOHS WITHIN 30 DAYS To P 0 Box 400, Sacramento CA 9:812-0400