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Stateof Cal i6rnio—Environmental Protection Agency t <br /> Form Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on bac Page 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite f 12-pit typewriter. Sacramento,California <br /> AL UNIFORM HAZARDOUS l. Generator'Y US EPA ID No. w Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST ' s r, of <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> t <br /> 0 r,Z 'i : >! T`�1 "k i;: I]1r' `(� B. State Generator's IDin <br /> •y <br /> n 4. Generators Phone i]1.A ,Y D{P� l,Al'S ',i,a N`tf_: " 'r!'�Y i`"r•cl...'l':t_.� .� �' �l 11912 <br /> W) <br /> I11 <br /> 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> W <br /> OD. Transporter's Phone <br /> f �, (87711748-30" <br /> `T 7. Transporter 2 Company Name <br /> C P P Y 8. US EPA ID Number <br /> x E. State Tronsporter's ID[Reserved.] <br /> QF. Transport®r's Phone } <br /> V 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID �. <br /> � <br /> ted F n`i" t., � ;<;f. H. Facility's Phone <br /> 1 1. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number t 12. Containers 13. Total 14.-Unit M <br /> tJ P ( 9 P PP 9 I <br /> No. Tye Quantity Wt/Vol I. Waste Number <br /> Z a. <br /> State <br /> a P- I'll 'T,, .. -a 21g.!, ,.,1s it iii r.r. <br /> §i G f, P p' j EPA/Other m <br /> E S > G DIM <br /> o N b. <br /> W� E It`°; Nr' Sf: 's:,"�t1'k B �.dtY (1P•: {1i,il�'1rJ"1 .A, �N1 i% }'fili r'!it�i'.1 a4ejl�}it <br /> State . « <br /> EPA/Other <br /> v A s1 1 'X F' x G DW2 <br /> e. <br /> 0 cp. ..!, .,F'r�if;i .ef; 1 :(it, "tGL ?,i?IC State <br /> o <br /> R ¢d:- i- ,`t 4" r. EPA/Other <br /> 10 jjyj CA <br /> LU d. <br /> a F- State <br /> z <br /> Z J1��i' fii i,HFn�I'"5 A$z,t`} Tl,!. ��'r Yft6itl 'I NA tC <br /> t W �. -- itil ��I.�B�Rt <br /> V "u EPA/Other <br /> ( A i / -, <br /> ZJ. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> t Off ; 3a i'rbi7 4kitlCt:IiiY�1 `�AfR�9 h (!} 0� .7�161i� � - a^Oil) b. <br /> , � 1 TGEGzt W6�1't0A - NAT42•-3 WATBI112•-3 (21 t j 342724-00107 - 0#01]C ACiD TA AC <br /> 9 � 141d. <br /> Q! <br /> Z( 15. Special Handling Instructions and Additional Information <br /> O <br /> Q �k . tf i<'>: rtY'°Rt:'fIIN, i'i:i'lsl �.YG'li; ±'v kY: U24P, °r4at'AI ;90�; g57 ?455 <br /> Z <br /> W <br /> J 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 /> Q marked,and labeled;and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> V <br /> NJ 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 to be economically <br /> practicable and that I have selected the�ractica6le method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> 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 waste management method that is <br /> O available to me and that I can afford. <br /> } Printed/Typed Name Signature, <br /> v I ,+ _ _.....-......... Month Day Year <br /> w i { <br /> 11 17.F Trans orter 1 Acknowledgement of Receipt of Materials <br /> � <br /> ts.t A Printed/Typed'Name Signature <br /> Month Day Year <br /> � S lTo <br /> W 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> Q( R I Printed/Typed Name <br /> LU Signature o fh Da Year <br /> V) R 4� Y <br /> Q rrl <br /> U 1 19. Discrepancy Indication Space <br /> Z A <br /> iC I > —C <br /> I o <br /> i c' <br /> L mz <br /> I ' 20. Facility Owner or Operator Certification of recei t of hazardous materials covered by this manifest except as noted in Item 19. "s> <br /> T Printed/Typed Name <br /> Signature -ti <br /> Y ,�•t'°t onth Day Year <br /> ® >C <br /> DO NOT WRITE BELOW THIS LINE. -tea a <br /> DTSC 8022A (1/99) <br /> EPA 8700-22 <br />