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Stale of Caidornia—Health and Welfare Agency Qepartment of Health Services <br /> Form Approved OMB No 2050--0039(Expires 9 30 91) Toxic Substances Control Division <br /> P ease print or type (Form designed for use on elite(12 pitch typewriter) Sacramento California <br /> UNIFORM HAZARDOUS 1 Generator s US EPA ID No M8nifeat No 2 Page 1 Information in the shaded areas <br /> Document <br /> WASTE MANIFEST G +� of is not required by Federal law <br /> 3 Generators Name and Mailing Address A State Manifest Document Number <br /> CAL FAIEI;li SLIMY C/O CATffiIM 11JUTWOM (TRUSTEE) 88131-887 <br /> P.O. BOX 2$0 DAVIS, CA. 95617 B State Generator's,lD <br /> 4 Generators Phone( 916) <br /> S 5 Transporter 1 Company Name a US EPA ID Number C State Transporter a IDLO <br /> ` <br /> NBEFINM SERVICES 47 D Transporter's Phone i2c _ yZ <br /> m 7 Transporter 2 Company Name 8 US EPA ID Number E State Transporter a ID <br /> 0 <br /> F Transporters Phone <br /> m <br /> 9 Designated Facility NaammeananddSite Address t0 US EPA ID Number G State Facility's ID <br /> REPIENRYJ <br /> 3 tJ , W�+.1`� 3 <br /> U H Facility s Phoma <br /> Z <br /> s 12 Contamers 13 Total 14 1 <br /> O 11 US DOT Description(Including Proper Shipping Name Hazard Class and ID Number) Quantity Unit Waste No <br /> No Type Wtivol <br /> cai a State 223 <br /> Z <br /> N CAi.Ti.CiilslP'fl1 RECULM VAM OMY T G !Other <br /> MA <br /> E b State <br /> ni R <br /> mT EPAJOther <br /> V O <br /> N R c State <br /> 8 <br /> EPA/Other <br /> W d State <br /> F <br /> Z <br /> U <br /> EPA!Other <br /> W LJ J <br /> to J Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> Z a b <br /> 011Y VAM <br /> c d <br /> Z <br /> O <br /> Q 15 Special <br /> Handling Instructions and Additional Information �s }�p� ��yry� tv <br /> LU BEAR FROM �Ei Maza GIUMV 1f�W BARLLM <br /> J <br /> J <br /> Q 18 <br /> U <br /> GENERATOR'S CERTIFICATION I hereby declare that the contents of this consignment are full/and accurately deacnbed above by proper shipping name <br /> and are classified packed marked and labeled and are in all respects in proper condition for transport by highway according to applicable international and <br /> national government regulations <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 <br /> p to be economically practicable and that I have selected the practicable method of treatment storage or disposal currently available to me which minimizes the <br /> present and future threat to human health and the environment OR it I am a small quantity generator I have made a good faith effort to minimize my waste <br /> U generation and select the best waste management method that Ea available to me and that I can afford <br /> z <br /> Uj Pnnted/Typed Name ��1`��'k�}�-ti' �C�,S�'Cti� Signet 11 t' Month Day Year <br /> C'u <br /> W RT 17 Transporter 1 Acknowledgement of Recei t of Mat als <br /> < A Pnnt <br /> a <br /> LL ypod Nam Signatu Month Day Year <br /> "s ¢n !!�. f �� <br /> O PjZja 1,2 31%A <br /> W O 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> TPrinted/Typed Name Signature Month Day Year <br /> E <br /> z_ <br /> 19 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> I 20 Facility Owner or Operator Certification of receipt of hazardous materials covered by this mandeat except as noted in Rem 19 <br /> T <br /> y Printed/Typed Name Signature Month Day Year <br /> DHS 8022 A(1/88) Do Not Write Below This Line, .+ <br /> EPA 8700-22 olue GENER4TCR SEA',S THIS CCPv '(? JG4', AoITHN 30 A�S <br /> (Rev 9-88)Previous editions are obsolete <br /> To p 0 Sox Sao, Scat^.n_i- CA 05E12-0:co <br />