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Ma ofColi,omio--EnWonmere .._-. ._- ._. _._. .. _-..._ _. _ .... ....._.�-....-.._ . <br /> Store { d Protection Agency `/ <br /> Form Approved OMB No.2050-0039(Expires 9.30-94) See Instructions on back of page 6. DepartmSa ra Taxes Substances es Control <br /> Mean print or type Farm designed far use on eliM(12pikh)lypwriler. Sacramento,Calilomio <br /> axxxxxxUNIFORM HAZARDOUS 1' Governor's US EPA ID No. Meatiest Document No. 2. Page 1 Information in the shaded areas <br /> Is not required by Federal law. <br /> WASTE MANIFEST of <br /> 3. Generator's Name and Mailing Address <br /> o Aldvana cl Moral Plating <br /> 4421 CiannwdUni lane, :;tackton, C1 95206 <br /> 4. Gerveromm s Pf— 1 209 982+-1104 <br /> 5. Tryapo er 1 Company Naar 6. US EPA ID Number <br /> 21st Gent ilea P. X4 ri 91 81 ( ni T)l C <br /> Z 7. TrmyaM 2 Company Name S. US EPA ID Number <br /> .ya 9. Designated Facility Name and Sas Address 10. US EPA ID Number 1 <br /> 7pZ 21st Century Fff <br /> 7� 2095 NESilw—Bs Driver Inst <br /> V Fernle 1 89408 981 91 E 31 31 <br /> 11. US DOT Description(including Proper Shipping Name,Hamrd Clan,and ID Number) 12. Cadatnets 13. Total 14. Unit ,. <br /> i-Z No. T Qu Wt/Vol r <br /> a'Ki, Hawatdous Waste solid, N.O.:;., 9, NA 3077, <br /> G Tic IIT-, (Hyc2s0.` ido 3ludgoy F1006, D00I <br /> s N Is. <br /> E <br /> tv R <br /> x A <br /> a2P5 T C. <br /> C <br /> z <br /> R <br /> Z d. <br /> W <br /> U <br /> /Z <br /> { <br /> ul <br /> Q I <br /> 0 15. Sperdol handing Instructions and Additional Information <br /> a 110ar Protective clothing as roquirc 1 24 Pour. 'rrkarrency Phones 800-648--9931 <br /> Z <br /> F rRc #31 r\atimal Pesixussc ()�ntPrs 800•-424-0302 ? <br /> J16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and aro classified, <br /> poked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. r <br /> If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> -u economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> N threat to human health and the environment;OR, if I am a small quantity gerpecdof. I have made a good faith effort to minimize my waste generaRo r and select the best <br /> K waste emeM method that is available to me and that I con afford. ' <br /> yQ fMnrd/Typed Nuhn �\ SignatwC_.,,' /!' Month Day Year <br /> U `l / — <br /> T 17. nese o 1 Acknowled emeM of IT of Marriab <br /> Z <br /> Q N PdntedR Name S[gno)ero �� // A4onalh Day Ywr <br /> a s <br /> w r <br /> 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> w e Printed T d Name <br /> T / YPe Signature Month Day Year <br /> LL e <br /> O e <br /> W 19. Discrepancy Indication SpaceIs <br /> ' <br /> N <br /> U A <br /> Z <br /> i <br /> L <br /> 1 1 20. Fo6l' Owner or Operator Certification of races t of hazardous materials covered b' this manifest except as noted I.item 19. , <br /> T Printed/Typed Name Sigrrlyre / - Month Day Year <br /> T '\ <br /> DO NOT WRITE BELOW THIS LINE. ' <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A (9/93) (Generators who submit hazardous waste for transport ouf of-state, ' <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />