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State of Colifornio—Environmental Protection Agency <br />j� Form Approved QMB No. 2050-0039 (Expires 9.30.99) <br />?T% Please print or type; Form designed for use on elite (12-pitchlewriter. <br />n <br />v <br />0 <br />C <br />} <br />L <br />Z <br />u <br />C <br />c <br />LL <br />LL <br />LL <br />C <br />LL <br />v: <br />Q <br />U <br />►i <br />See Instl'utrtions on back @ �. Department of Toxic Substances Conlrt <br />l ) i,,: ., <br />DO NOT WRITE BELOW THIS LINE. <br />DISC 8022A (1/99) L <br />.. .i s�. .0 t i <br />EPA 8700-22 <br />UNIFORM HAZARDOUS <br />l . Genera US EPA It9 No. <br />Manifest Document yo. <br />- oacromento, California <br />Informatign,in the shaded areas <br />WASTE MANIFEST <br />is not required by Federal law. <br />Of <br />3. Generator's Name and Moiling Address <br />A. State Manifest Document Number <br />IA�,L'PA P1,KPING, INC. <br />LnL� <br />i.13 17. ; i .C' i I. SI.AUS ci 17r;l±2_,q, <br />B. State Generators ID :, ! <br />A. Generator's PhoneJ. <br />(nj 1`1141 CA <br />(V <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C State Ttons porfers 1 Res <br />rA!fn.wP' •c.!R.R TR'4:..a 4+yw., <br />D Transporter', Phone <br />` <br />7. Transporter 2 Com an Name <br />P P Y 8. US .EPA Ip Number <br />E. State Transporters ip e I <br />J <br />Q <br />J <br />Q <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />F. Trans' orters Phone777.7777 <br />G. State Fact 1P <br />) <br />� 5 <br />r <br />L t ::stella rel <br />"� <br />I 7 y <br />i <br />kl�yj, New l all s Dr.. F:aSt <br />H: FacillyI, <br />J(inc11. <br />luding <br />US DOT -Description includin Proper Shipping Nome, Hazard Class, ID <br />2• Co <br />ainers 13. Tot I <br />4. i ` <br />and Number) <br />P PP 9 a. <br />No. <br />Type Quantity <br />Wt/Vol t)y. Waste.Numbar1 <br />C <br />$tate , <br />G <br />betii enaY:1 ti,�n;,ki4 a�:,u �Ur.i1'i.irrA u VN:�:d cyst iLQ1U��ti tikafl�4f <br />rE <br />b. <br />0/ <br />T DAI <br />Os P <br />N <br />°o E <br />fc<i i1,iIt111iU1>: tlAS5ur illi„ 9 KA34`17 MI)i 3(2IPGt7:' <br />M <br />a A <br />3 t i i i <br />C. <br />t <br />0 3 (, 0 0 <br />PPAI <br />> T <br />7 O <br />c R <br />d. <br />r <br />�tgfe <br />J <br />, PA/Qtfwc <br />11 <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Code,'Fgr Waite,Isfed <br />�- <br />Above <br />r <br />a) 333566-01 Jfiff7 - Ci{60NSL' ACID - "YBi_g ill b! 194203-95 - Ytl6fi FTL'C�CAD;b <br />1 <br />15. Special Handling Instructions and Additional Information <br />•• eGfl 2# hOLA KyFRGFNCy IMPOSE, CALL (323) 776-6233 <br />'. <br />tEAt'tonk PI±Oi`arin CLOTURG, rAERGENCY 585,QnSE PSOdE (609) <br />048-9S31 1775', 575-2777. <br />16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately 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, t certify that 1 have o program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be econotnicaify <br />practicable and that I have selected the �rocticable method of treatment, storage, or disposal currently dvailable to me which minimizes the <br />and the environment; OR, if I future <br />am a small quantity generator, I have made a good faith effort to <br />available to me and that I can a <br />afford. <br />present and threat to human ecolth <br />minimize my waste generation and select the best waste management method that is <br />lintedjTyped Name Si nature <br />Day <br />1 <br />0 <br />17. Transporter 1 Acknowledgement of Recei t of Materials <br />%year <br />NAPrinted/Typed <br />Nome Signature <br />S <br />'*-J :` � --.t, r? a .•� __ <br />Month Day Year <br />y <br />0 <br />18. Trans orier 2 Acknowledgement of Recei t of Materials <br />��c .moi--.�...— O �a /' d l <br />IPrinted/Typed <br />Name <br />Signature <br />E <br />R <br />19. Discrepancy Indication Space <br />Month Da y Year <br />F <br />A <br />C <br />I <br />L <br />1. <br />20. Facility Owner or Operator Certification of recei t of hazardous materials cove,ed,by his manifest except as noted in Item I.Y. 1 <br />Y <br />Printed/Typed Name Signature <br />Month <br />Day -nth Year _ <br />DO NOT WRITE BELOW THIS LINE. <br />DISC 8022A (1/99) L <br />.. .i s�. .0 t i <br />EPA 8700-22 <br />