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t: r State ofCalifornior-Environmental Protection Agency <br /> f• f Form Approved No.2050-0039(Expires 9.30-92) t/ � <br /> Please print 6r type.ype. Form'designed for use on elite(12 pi 'qr,� <br /> Department of Toxic Substances Cant <br /> UNIFORM HAZARDOUS f GWWWO/a US EPA ID Na. .3 67 1 Sacramento,California <br /> Manifest DocumegtMo. Information in the shaded areas <br /> WASTE MANIFEST is not required by Federal low. <br /> 3. Generator's Name and Mailing Address 3 1 '� 4 ."1 <br /> INC. <br /> y �� T did ��' � ee .a',.�h •• <br /> � 818 S- S"1'AN1.ilAtJ5 bZ'121+j,,'P i <br /> 4. Generator's Phone <br /> 0"M*`MN.CA 95206209 948-2768 <br /> N <br /> S. Transporter 1 Company Nome w -' > <br /> `n 6. US EPA ID Number <br /> CP <br /> O 12Ls1. Q!MVHX IMI <br /> CP 112 <br /> 7 Transporter 2 Company Nome • <br /> _ 8. US EPA ID Number <br /> Q ;'S tW°9"p;7iLM <br /> M V 9. Designated Facility Name and Sit®Address % Y a <br /> 10. USE ID Number ""• <br /> QQ z 21 s r.. lien t ury all <br /> r � • <br /> 0 2095 .dew l ands Dr. East <br /> C � <br /> 1 1. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12• Containers <br /> 13, iota 4 Unit <br /> ZFlak__, J:A:�i��� <br /> Quant; Wt/Yol Wosti'Nu" SO01" HYDRURIDS SOLUTION 6 UN1824 ?GII QQ(D992) UG(I54�3 G E (ONO Tti a°ao E <br /> � R d t <br /> C14 A <br /> C. <br /> o Tco <br /> 'EP•A/S�thiu• <br /> ® (<N <br /> a�, <br /> W <br /> d. <br /> O J. Additional Descriptions for Mot <br /> CIL <br /> a) 341611-99 SODIUI <br /> Pat <br /> ZTl:�kig <br /> 0 15. Special Handling Instructions and Additional information <br /> "' r <br /> z ?R0TKCYIvfs CLOTHING. <br /> W lBN6sGSl1CY PSSPO9SE'?NONE-(89®5)x567-1955 <br /> F•- <br /> J <br /> Q 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment aro fully and accurate)y d®scribed above b ro <br /> V marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable;nTurnat;ona(anti nafano� <br /> Y P Per ship ing name and are classified,packed, <br /> government regulations. <br /> dIf t am a large 'hot l W generator-,I certify that t hgyq a min pl«a to reduce the volume and taxicify of wQih a " <br /> V) Practicable and that I hove selected the practicable met hodeatmenf,storage,or disposal tureen avails g Oersted to r <br /> Oiland the environment;OR,if I am o small quantity generator,I have made o good kith effort b minimize m Qac mfnimlzes diems Lhgva determined to be economically <br /> Q available to me and that I can afford. Present and future threat to human health <br /> Y generation;and select the risk waste management method that is <br /> UPrint a ame <br /> Z 1.. A ? :G...- nth Do (Dear <br /> W �f <br /> 0 T 17. Trans orter 1 Acknowled omen(of Recei f of Materials <br /> w A Printed/Typed Name <br /> wR Signature , ,_ <br /> F <us O L. ., t:. _ Month Day Year <br /> W 0 18. Trans orter 2 Acknowled ement of Receipt of Materials ""� -'"e-" d <br /> 0 T Printed/Typed Name <br /> W E Signature <br /> N 8 Month. <br /> Q �Y Year'•' <br /> V F 19. Discrepancy Indication Space <br /> Z A <br /> C •;,' `. <br /> 1 <br /> L <br /> ( 20. Facili Owner or O orator Certification o ace I of hazardous materials covers f is manifest sx• f as n " <br /> T Fitn(yed/jyeed Nome / I 2 <br /> Y f f Signa�re f" �f��%r <br /> 1��/i'•s"!,<�+Q )_ Month Year✓ <br /> DO NOT WRITE BELOW THIS LINE. <br /> DISC 8022A(1/99) `SPF ;_,NDS Ti11S r OPY TO GENERATOR WITHIN 3U DAYS, <br /> EPA 8700-22 IS Who sul hazardous waste for transport out-c state, <br /> I'- ,Py of this copy and send to DTSC wuhin 30, days.) <br />