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J <br />State of CARfornia—Environmental Protection Agency <br />Form Approved OMB Nos CSO -W29 (Expires 9-30.99) See Instructions on back ofa 6. Department of Toxic Substances Control <br />lease print or type`" Form designed for use on elite (12 -pitch) 1101-r.0 Sacramento, California <br />a <br />u <br />u <br />C <br />L <br />3 <br />r <br />c <br />C <br />a <br />a <br />C, <br />C <br />C <br />a <br />a <br />LL <br />t- <br />2 2 <br />u <br />L <br />LL <br />V <br />a <br />V. <br />LL <br />ac <br />4 <br />2 <br />C <br />t - <br />a <br />2 <br />LL <br />F <br />4 <br />L <br />CL <br />C <br />C <br />} <br />C <br />Z <br />LL <br />C <br />Uj <br />W <br />u- <br />0 C <br />w <br />En <br />Q <br />U <br />VA <br />UNIFORM HAZARDOUS <br />1. Generator's US EPA ID No. Manifest Doct.ment No. <br />2. Page I <br />Information in the shaded areas <br />WASTE MANIFEST <br />/' e /� •7 q a f 3 " <br />V' Q <br />j_ �T <br />F7 tC/' <br />of <br />isnot required by Federal law. <br />3. Generator's Noone and Mailing Address <br />A. State Manifest Document Number ,.,� ;� A <br />bt <br />N�p%2 <br />B. State Generator's ID <br />lj + <br />A. Generator's Phone (Rq ) �� {✓ly.�� <br />1 <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter's ID [Reserved.[ <br />I <br />! <br />D. Transporter's Phone <br />t <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID [Reserved.] <br />i <br />F. Transporter's Phone <br />t <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />—d'—C XV'. r'xr'S�1"TF4a'71 sINi'l! 1` Ts'"3. �h-= <br />Lr.iv L'aJ9../ 1 9W Vr• 1 V19L 3fYuvv r ilfr_e.a <br />�4�9 g+AiRRK 820VE, <br />H. Facility's Phone <br />sI Q PA %Q 9141-316 31912 <br />10 <br />j <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />Quantity <br />14. Unit <br />Wt/vol <br />I. Waste Number <br />No. <br />Type <br />a. <br />'dsii�sa�. f — E-WIP i 1 is 4i iL3� TANK K !"IS� I IG <br />D / 0 00 <br />State q <br />EPA/Other <br />_ <br />C' <br />E j --",i ';ars i � Ae t�.ru� i v` ie i , 4a+ �i <br />� <br />1-1%4,1 <br />,.. i. a <br />.� <br />w- <br />N <br />b. <br />State <br />E <br />R <br />EPA/Other <br />T <br />c. <br />State <br />O <br />R <br />EPA/Other <br />d. <br />State <br />EPA/Other <br />J. Additi n I De ns for Materials Listed Above <br />-V- E%Vn�'STORAGE TANK PIPING <br />K. Handling/odes for Wastes <br />Listed Above <br />a. qq <br />6 <br />pIplt c <br />c. <br />d. <br />15. Specia_l H.andling instructions and Addition- al Information <br />ta <br />"Veal 'J!L_Cr=iL9.Sll:i mTy.. <br />J. <br />_! ale—t y-.'d..8..p..=w�.. <br />aeSps a�w?yne.^. <br />030o� sjvc. aA/ 6A <br />Aa <br />•3 ei ... «.a.....a. <br />3'sv"3 a°' i �urr't+.>i 4 "7d <br />F1 6. GENERATOR'S LMTIFICATION: I 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 Bean . generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to 6e economically <br />and that 1 #cove selected the method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to Human health <br />practicable practicable <br />and the envirow~4, 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 can afford. <br />Printed/Typed Name .Signature <br />Month Day <br />g /' <br />1\ EVA f1 JC ' 1 l�V\' "A:�5 i� ii>t aS <br />/Year / <br />0 1 <br />Pi <br />7. Transporter I Acknowledge ent of Receipt of Materials <br />A <br />Print /Typed Name <br />�l/LI�-7 �B <br />Signature — <br />1,,�onth Day Year <br />Z J <br />F <br />l t�- 7l is <br />/mss--- <br />Jlr <br />I <br />0 <br />18. Transporter 2 Aclinnor*4edgement of Receipt of Materials <br />R <br />T <br />Printed/Typed ed Name <br />YP <br />i nature <br />g <br />Month Da Year <br />Y <br />RI <br />19. Discrepancylndication Space <br />F <br />A <br />C <br />L <br />I <br />20. Facifiry OwnerorOperator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br />T <br />y' <br />Printed/Ty ed Na/reie <br />Signature <br />Month Day Year <br />2 <br />V l 1O- <br />0 I ZI 0 1/ <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1;99) <br />EPA 3700-22 <br />