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00-- <br />C <br />0: <br />C <br />C <br />0 <br />0 <br />C, <br />0 a <br />Q <br />C <br />a <br />LL <br />Q <br />L <br />CL <br />V <br />CX <br />C <br />} <br />L <br />Z <br />U. <br />LLL <br />ac <br />LL <br />w <br />to <br />Q <br />U <br />G <br />State of Colifornio—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9.30-99) See Instructions' <br />oft backage 6. Department of Toxic Substances Cont <br />Please print or type. Form designed for use on elite (12-pitc .typewriter. <br />UV NUI W KIIE BELOW THIS LINE. <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />UNIFORM HAZARDOUS <br />1. GeneratorUS EPA`i'i7 No. Manifest Document No. <br />` <br />2. Page 1 <br />Information in the shaded areasV <br />WASTE MANIFEST <br />is not required by Federal law. <br />c Ac. t r. <br />of <br />3. Generator's Name and Mailing Address <br />A. State Manifest Document Number • <br />iii,.:. <br />�y /� �n/� P� (� <br />4 IG: '"f 't V 9 <br />:a'i'r1:t#P-3T.A0.' ::i 1'11i �.;.t' <br />B. State Generator's ID <br />4. Generator's Phone t;'11X.,1'f)�PA (', tr7R?aN:: i etJ <br />IH I Al HI IN 316101Or 61119121 <br />.4 <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter's ID Reserved.) <br />7 <br />D. Transporter's Phone 748-30" <br />_ <br />7 Transporter 2 Company Name 8. US EPA laNtmber <br />E. State Transporter's ID (Reserved.) <br />j' <br />(F. <br />Transporter's Phone ~ <br />J <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />�urtUililiKt'I fir I!«i '1 f:. <br />H. FacilitysPhone` <br />1 1. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number( <br />Containers <br />13. Tofa) <br />14. Unit <br />No <br />No. <br />T e <br />Quantity <br />Wt/Vol <br />L Waste Number <br />Stole <br />792 <br />E <br />�� U + <br />try) <br />,P 17 <br />`, <br />EPA/CNher DIM <br />E <br />(l'yb s�ittJl�"l.; Kvti(l.Jh <br />'SIG to <br />I R <br />' A <br />'t 1 <br />ri L.F <br />�' <br />G <br />EPA/Other <br />M02 <br />i O <br />G <br />";� -�li.l rHNi'lii' Adc1) :�f71,0*i (:;.RUX �ttir)) <br />State ' <br />R <br />y ; 1, of <br />i FL <br />T <br />EPA/Other <br />D�b2 <br />f <br />d <br />:?.�; }ii.'k{lihfl7'i 5r'"A`'f')., i,jlli:, >t!.iV _,. iYiFf•6; "! faA:itl''• rtil), �4fE'OMi.i <br />State <br />6 A/ <br />/ <br />� <br />EPA/Other <br />J. Additional Descriptions for Materials Listed AboveIi <br />K. Handling Codes For Wastes Listed Above . <br />A) 3399'4--41 R13 - CHRONIC ACIii - VAT44-8 VItT814-6 (i) ai 341611-41 -'50010 <br />a b. <br />fill t0Xt)Ju WL911`119 . 11042-3 NAT641-3 (21 cj 34272.4-4N 0147 - CHaodle jejo ThiC <br />:�Lfi;3GR - 1,1Tt44-1 GF�Sb134-5 {3) Q} A`94143 1 F8N tILTERALS - SUh13 j4j <br />C. <br />d. <br />15. Special Handling Instructions and Additional Information <br />1 <br />Nf;A.a 41i.)�'>;i: it+i''.;'1'fu:fi!!K itis)x'ijlkii i?�G"tt�dRJvg 1(L'..�Ft!l(56 Ffil(+Af: ;9dY; 467-'IA35, <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurate)y 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 <br />and national government regulations. <br />If I am a large quantity generator, I certify that 1 have a program in place to reduce the volume and toxicity of waste <br />and that I have the <br />generated to the degree 1 have determined to be economically <br />practicable selected practicable 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 />available to me and that I <br />can afford. <br />Printed/Typed Name <br />- ,., Signature, <br />_ Year <br />B <br />17. Transporter i Acknowledgement of Receipt of Materials <br />=MonthDay <br />{ <br />A <br />k <br />Printed/Typed'Name Signature <br />- <br />'1 <br />Month Day Year <br />P <br />{ c 1. i r�' /! !' i s.t .: ..{_ �.j („ 1, <br />'e. t f <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />TPrinted/Typed <br />E <br />Name <br />Signature <br />o rh Day Year <br />R <br />� � <br />19. Discrepancy Indication Space <br />F <br />A340 <br />C <br />axils ."iC <br />1 <br />L <br />1 <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest exce r as noted in Item 19. <br />T <br />Y <br />Printed/Typed NameSignature <br />ms's. <br />C? onth Day Year <br />.{•-t4 <br />>C <br />UV NUI W KIIE BELOW THIS LINE. <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />