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State of California—Environmental Protection Agency <br /> "y Form Approved COMB No.2050-0039(Expires 9.30-99) See Instru¢tions on bac ., Department of Toxic Substances Control <br /> - Please print or type: Form designed for use on elite(12-pilo rrypewrifer. ) �.� <br /> ' Sacramento,California <br /> UNIFORM HAZARDOUS 1• Generator's`US EPA ID No. Manifest Document No. Information in the shaded areas <br /> WASTE MANIFEST is not required by Federal law. <br /> of <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> I 1A l'� PING, INC. <br /> O <br /> 221982,944 <br /> Li 16 S. ')'!'AN <br /> f`,I,T01JS E'L' B. State GeneraiWei ID �' <br /> h 4. Generator's Phone (,p <br /> T y�, c t��t _. J'f''t� <br /> LO CV 5. Transporter 1 Company Name 6. US EPA ID Number C. State Trans- <br /> CP <br /> rans <br /> O D. Transporter'Phone, t <br /> r.�.- 5 c r <br /> 7. Trans orfer 2 Com on Name° - f - <br /> R P Y 8. US EPA ID Number E. State Transporter's ID I&ejLrv2dj <br /> .J.I <br /> Q F.Transporter's Phone a <br /> U 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Faci i ID <br /> i;eltucZ t• '2QY f <br /> _...m_, . <br /> 0 !479`, A4v4l1 d2it:lu Dr,, F'a.`s.'t <br /> H. Facility s Phone <br /> CIQ <br /> !✓ V 2. CO alners <br /> U 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 13. Tot4l 4 t 5.. <br /> Z a. No. <br /> Q Type Quantity Wt/Vol s'I,`Waste Number` <br /> S state" <br /> ~ Lt�J 947:i>Au V13 d'a°f1aN <br /> G nV1u Jkl J16i1 dV$ a YHA 1�} cVl� �a1610�4t is�65(j}{l <br /> o NE b. ® / T 7 Irl. O �EPAJ <br /> auta� <br /> 00 E 2`i :u,i;ui;;tl'ut; kS°u, iUi` a.J 4't: ! gA,Il <br /> v R EPAlOther <br /> �. A i '1� i3 0 3 d o 0 <br /> o T C. <br /> m O Mate <br /> R EPA/Other <br /> LU d <br /> Z Shste <br /> w <br /> U <br /> LU <br /> EPA/Otho; <br /> .y <br /> Z J. Additional Descriptions for Materials Listed Above <br /> Z K. Handling Codes for Wastes Usted Abays <br /> CL o 3395bb-64 U11AT - cHkoftTC ACID - aA wa 11) b) 1911113-Y5 - Y1�6 FILM <br /> � b: <br /> V' <br /> oc ,,TIUas (2) <br /> Q <br /> C. d, <br /> 0 15. Special Handling Instructions and Additional Information <br /> '' •• rG9 21 h0a8 !a E1it;Y "SPONSE, C,AlL )323) 776-6233 <br /> Z t str >1tt1 th ?wxi ,cn Lviw aG, taERGENCY yE`EONSE M09 Mill) 140-9931 1775) 575-2777. <br /> w <br /> t— <br /> Q16. 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 /> U marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> J <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 to be economically <br /> p�actica6le and that I have selected.the practicable method of treatment,storage,or disposal currently dvailable 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 /> 0 available to me and that I can afford. <br /> 0 <br /> ?- PrintedjTyped Name Si nature <br /> V �a - Month Do Year <br /> Z i It Ew sd®^ 1 <br /> w c� <br /> 0 T 17. Transporter I Acknowledgement of Recei t of Materials <br /> R <br /> w A Printed/Typed Name Signature <br /> ..o` S Month Day Year <br /> 0 R 18. Trans orfer 2 Acknowled ement of Recei t of Materials <br /> 0 T Printed/Typed Name <br /> tw E Signature Month Day Year <br /> Q .R <br /> U F 19. Discrepancy Indication Space <br /> Z A <br /> _ c <br /> I <br /> L <br /> 120 Facility Owner or O erotor Certification of receipt of hazardous materials covered by this manifest except as noted in Item 1,9.i' <br /> T Printed/Typed Name <br /> Y Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DISC 8022A(1/99) <br /> EPA 8700-22 <br /> 1 <br />