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Skate of Califarmm—Environmentol Protection Agency <br />' Farm Approved OMB No 2050-0039(Expires 9 30 99) s See Instructions on back of page 6 Deportment of Toxic Substances Control <br /> Please print or type Form designer(for use an elite(12 pitch)typewriter Sacramento California <br /> UNIFORM HAZARDOUS 1 Generator s US EPA ID No Manifest Document No 2 Page 1 Information in the shaded areas <br /> is not required by Federal law <br /> WASTE MANIFEST �� 71 U 2 2 510 � 1 #� of I <br />' A State Manifest Document NumberPAUL SID-1-M ` <br /> 3 Generator s Name and Marking Address raj <br /> 0835359 <br /> rA32 R7AI F 3SILs00 M) �ySTOCK 1 ON, CTS 95205B State Generator's ID <br />' h 4 Generator s Phone f 209 146-7 1006 <br /> n <br /> N 5 Transporter 1 Company Name 6 US EPA ID Number C State Transporters ID Reserved] <br /> W') <br /> W <br /> D Transporter s Phone <br /> AMEMCIAN 44 LEY WA TE, 04- <br /> m 7 Transporter 2 Company Name 8 US EPA ID Number E State Transporier's ID fReserved] <br /> J <br /> �Q F Transporter s Phone <br /> U 9 Designated Facility Name and Site Address 10 US EPA ID Number G State Facility s ID <br /> ",'rr p1w�yi'„01()9 T' p, t�'y p t ! �y s� H Facility s Phone <br /> an O ti1_iys"? t1'7*L�.~9���1 {'► lit �7illd�: 4i I7 :.7 15 12 8 <br /> � 12 Containers l3 Total 14 Unit <br /> V1 I U5 DOTDescription(cmc`luid�9mg9Proper <br /> 6Saharyp�pm�g Name Hazard Class <br /> t �and I!D Number) No Type Quantity Wt/Vol I Waste Number <br /> Z " �aN Rf,rl`A F'6►�41_NifJiarl S RrnFNS�i E i K;101i i State 22 6 <br /> 3 G (�( SIL WA 1 UJI? EPA/Other <br /> r <br /> f <br /> CN E b State <br /> N <br /> m E EPA/Other <br /> v R <br /> v A c State <br /> o T <br /> W O EPA/Other <br /> R <br />' 04 w d State <br /> H <br /> Z EPA/other <br /> V <br />' 1 Additional Descriptions for Materials listed Above K Handling Codes for Wastes listed Above <br /> � a b <br /> OIL &WATER <br /> c d <br /> a <br /> Z 15 Special Handling Instructions and Additional Information <br /> 0 41PRO RIA i F PRO1 EC T)VE CI-01 VING 'tri T t A0DR1--',S <br /> t w _ / 7 O 7 ON. <br /> �y� t� 11 <br /> = wwMW 7. f I �`}I i,�rr � ! ,Tf�N. ...C'3�£�"f.dry E3.J <br /> 16 GENERATOR 5 CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and ore classified packed <br /> Q marked and labeled and are in all respects in proper condition for transport by highway according to applicable international and national government regulations <br /> IF I om a larged quonfrly generator 1 certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I hove determined to be economically <br /> a prachcoble anthat I have selected the rocttcable method of treatment storage or disposal currently available to me which minimizes the present and future three!to human health <br /> u) <br /> and the environment OR if I am a sine I quantity generator I have made a good faith effort to minimize my waste generation and select the best waste management method chat is <br /> available to me and that I can afford <br /> O ;noted/Typ Name F ) ^ Signature Month �rDay Year <br /> LU T 17 Transporter I Acknowled ement of Receipt of Matelpals <br /> R v ! Month Day Year <br /> LU Printed/Type a Signature !� <br /> 1 R • r <br /> w P ✓ �} ,-) <br /> 0 0 18 Transporter 2 Acknowledgement of Receipt of Materials <br /> T Printed/Typed Name Signature Month Day Year <br /> ui E <br /> t R <br /> laj 19 Discrepancy Indication Spate <br /> z F <br /> A <br /> C <br /> L <br /> I 20 Fac lity Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Hem 19 <br /> Ponied/Typed Name Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE <br />' DTSC 8022A 11/991 Yellow GENERATOR RETAINS <br /> EPA B700-22 <br />