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kState of California—Environmental Protection Agency `z� <br /> Form Approved OMB No.2050-0039(Expires 9-30-99) See Instructions'on 6361[." e 6. <br /> Department of Toxic Substances Centro <br /> Please print or type. Form designed for use on elite(12-pik ,iter. MW Q 1006 Sacramento,California <br /> 4 <br /> A NIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. ,2_Ppge 1 Information in the shaded areas <br /> i WASTE MANIFEST is not required,by Federal law. <br /> CAD 61884 52 543 5; `4 ' & Edi of_.. <br /> 3. Generator's Name and Moiling Address <br /> 1�13d:I`A C'l., t`-lr1 Ah;, 1NC . `F <br /> .a 6,0 <br /> to <br /> i; to A. Generator's one <br /> n GtPhl�ro�'iYX'Y,"iC}Mi i'..A C3�,?.tAFi (209)448-2768 <br /> 2 <br /> tV 5. Transporter 1 Company Name 6. US EPA ID Number ' ra <br /> a <br /> ;?1's t. c 13C19,44N 041 C, A R y 0 f 0 5 2 8 0 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number �4i7"' -•- ---• <br /> J r" <br /> ��.. 9. Designated Facility Name and Site Address 10. US EPA ID Number {- <br /> (VQ 134AtL'1Wy1N:tN FWV. ➢tt7*fi:NL'AI,, 1WK KE24T V � �, ��, :•�> <br /> D <br /> 20245 77M AAV <br /> a.�� Kfi IA 41v. lam <br /> '.Nv 12: Carltainsn 13.Total- 14. Unit -• :- <br /> 1 1. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) �'•i <br /> No. T Quantity wt/vol 'd. Waste Numbqr•< <br /> Z a. <br /> BASTE LSAsIiiKS, ihokt: lc, : ?l.ili, M.U.S. (COPPER, CYANIDE ull171 <br /> 3 G 63'1.'9'f'Kst E.i 0h88 PCI] 'TOYIC, MQIui41l tac(14T10 C F P <br /> o N b. <br /> 00 <br /> ao E <br /> 4 R <br /> v A <br /> Stall <br /> C.00 O <br /> R <br /> .Vita <br /> 1W- d. <br /> Z q <br /> w a � <br /> w I, <br /> N J. Additional Descriptions for Materials listed Above <br /> y � t <br /> p a1 3!1425-pa IsilB - CYAtIIl11; TAX[ 8 IMC16 (1) <br /> W <br /> d. <br /> O 15. Special Handling Instructions and Additional Information CALL (!i�>?) 56T '7655 ass _ <br /> r- <br /> Z &nJP t3UPRF Nii4T(1f;4TJ4 CiOi IRb: MNh6'68NCY RESPONSE PHONE (all) 567-1155. :t <br /> z a_ <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper slappfnQ name <br /> and ars'elassiffed,packed, '' <br /> V marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable interngtfonal and national government regulations. <br /> _+ if I am o large quantity generator,1 certify that I have a program in place to reduce the volume and toxicity of waste generated to the degiel I have determined to be economica11 <br /> N practicable and that 1 hove selected the Practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future throat 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 /> ce available to me and that I can afford. <br /> O <br /> Z P!t '4 typed Nome 7Mon Da� (J <br /> w T 17. Transporter 1 Acknowledgement of Receipt of Materials RV <br /> Panted/Typed Name / Signature _ Month ; Day Year <br /> LU <br /> t V ,! r i;f fi (�y(/ '�{ ' +-•-"--- �, Ila CJ <br /> .� <br /> O0 18. Transporter 2 Acknowledgement of Receipt of Materials - - -- -- -- .- <br /> T Printed/Typed Name Signature Month Day Year <br /> V) R <br /> Q <br /> V 19. Discrepancy Indication Space <br /> F ; <br /> A <br /> C <br /> L .;� a <br /> I 20. Foci I ity Owner or Operator Certification of receipt of hazardous materials covered by this manifest exco t as notedlrrhmlO., It <br /> T Printed/Typed Nome Signature f ,:7 <br /> Month ?Day Year, <br /> DO NOT WRITE BELOW THIS;LINE. <br /> DTSC 8022A (1/99) <br /> EPA 8700-22 - Yellow: GENERATOR RETAINS <br />