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State at ii-%itornip-tnvironmentai rrotecryon Agency, ''��" <br /> Form Approved 6mB No.2050--'0030(Ezpires'9-30=99{ S@@ (RStrtxtiOm On back" fgge'6. " f)epa�rfinent of <br /> iizic Substances+ontr <br /> Please print.or type,;Form designed for use on elite 172-pitch)typewriter. Sacramento,California <br /> 1. Generator's US EPA ID No. ManiFest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS _ is not required by Federal law. <br /> WASTE MANIFEST r10 t - <br /> 3. Generator's Name and Mailing AddressSO I I mw " <br /> r$}a atPast Dccslmen(hlttiRo! <br /> P <br /> 7�y9�a r I <br /> . B Sftrie 6CnYafor$ID �' t' <br /> r ` sz4. Generator's Phone ~ ' + <br /> h CN 5. Transporter 1 Company Name 6. US EPA ID Nu ber hlpTragsportgt�s ID i e9 t< k tt <br /> x�r t M? r s r ,'�' v l a ` l F ) i >!lriie <br /> Go <br /> 0 ¢fY7>~.£s t r , 3 Yi a_Y t f... Z.J s d., — <br /> o? 7. Transporter 2 Company Name 8. US EPA ID Number <br /> V 10. US EPA ID Number tR act tfy s <br /> 9. Designated Facility Name and Site Address <br /> � r <br /> b-�VIks(h. OiL <br /> � 1 °w_ *: )-f rad <br /> 1O 71 1 <br /> Y 12. Containers 13. Total X14. Unit N� ,' <br /> Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) s <br /> e V <br /> No. Type Quantity Wt/Yol <br /> M <br /> I Z °• qq y y pn }YY pp q <br /> R w✓3. Ir{" :r°, )"AZAfi'00q�)S WANTF. �_.)1..e1i0H' <br /> 3 er. <br /> E <br /> o N b. <br /> ,. ,. <br /> 00 <br /> 00 E EPA/Other <br /> AC. <br /> crake, <br /> 00 O <br /> z �. <br /> LU d. ��a•; <br /> z ��s �. <br /> LU <br /> Z <br /> a <br /> to <br /> U.1 <br /> Z 15. Special Handling Instructions and Additional Information <br /> t— <br /> Z G s <br /> U-1 <br /> `_: E-'KICY PHONE <br /> S <br /> I— <br /> 16. 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, <br /> marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and notional government regulations. <br /> If I am a large quantity generator,1 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 /> a procticaple ai m <br /> nd 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 /> to and th.,enyanent;OR,if I am a smaquantity generator,I have mode a good faith effort to minimize my waste generation and select the best waste management method that is <br /> cl� available to me and that i can afford. <br /> Signature ;.t- i° an y J+'bpI- <br /> y Printed/Typdd No e / 9 f r nt y� <br /> Z ,: <br /> w T 17. Trans '{ r 1 Acknow ledgement of Receipt of Materials <br /> W p Printed/ No a Signature' O�thf! °y <br /> W <br /> w S <br /> O18 <br /> P . Trons iter 2"Acknowled ement of Recei t of Materials <br /> TPrinted/Typed Name Signature Month Day Year <br /> LU E <br /> R <br /> Uj 19. Discrewncy Indication Space <br /> Z_ A _ <br /> C <br /> F <br /> L <br /> 1 20. Facility Owner or Operator CertiFicotion aF'recei t of hazardous materials covered by this,ritanifest except as noted in Item 19. <br /> [lignature -Dpy Year <br /> Pinlerl�TypedName, 1 /� r` 'ter <br /> Yz ", <br /> DO NOT WRITE BELOW TF115 LINL. <br /> ychl, , TSDF SENDS THIS 00PY TO GFNF-,BATOR WITHIN 30 DAYS.. <br /> iG er wk6m-t llaznrdou ,vruto tor frcnspm out of state, <br /> DTSC 8022A(1/99)$ this cony n,nd send to DTSC within 33 daysl <br /> FPA R700-72 <br />