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,ro—Enmronmmnal Protection Agency / <br /> See IDSfrUCfIOD$ On 6O01( d1j� epa <br /> Oge 6. Drtmem <br /> of Task Substances Conn <br /> A OMB No.2050-0039(Exp'nes 9-30-96) <br /> .or type. Form designed for use on elite(12pikh)typewntec Sacramento,California <br /> /UNIFORM HAZARDOUS 1. Gerserotefs US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> f WASTE MANIFESTis not required by Federal law. <br /> .. I of <br /> 3. Generabi s Name and Moiling <br /> rp g Address �� A. State Manifest Document Number <br /> CESV EjD rlAr <br /> 0 a <br /> B. State Generator's ID <br /> 00 <br /> 4. Generator's Phone ( ) <br /> 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID t j <br /> 1� C ( <br /> - _ D. Transporter's Phone <br /> U7. Transporter 2 Company Name 8. US EPA ID Number E. 5 ate Trnm.•.+ :.In <br /> i <br /> Q - F. Trdmponer's Ph <br /> y--s Z 9. Designated Facility Name and Site Address 10. US EPA ID Number G. Stale FxiIWs ID <br /> H. Facility's Phone <br /> r% Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> No. I Type Quantity Wt/Vol I. Waste Number <br /> Staft <br /> M G e' y 4 t EPA/OIMr <br /> m E (; <br /> N E <br /> < R r.. Z �' EPA/Ceher <br /> 0o A . . - v <br /> m T G Stab <br /> O <br /> w R EPA/Other <br /> t— <br /> yZj d. .t Stab <br /> U <br /> N EPA/Ctlher <br /> Z1. Additional Descriptions for Mabrials Listed Above <br /> Q P K. Handling Codes for Wastes Listed Above <br /> W . . g. <br /> It. <br /> W _ <br /> c. d. <br /> Q <br /> Z <br /> 0 15. Special Handling Instructions and Additional Information <br /> Q <br /> Z <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping rwme and are classified, <br /> Q packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> U <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 Is be <br /> Q. 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 b human health and the envirommant; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> Owaste management method that is available to me and that I can afford. <br /> Printed/Typed Name i9 rot Monty Day Year <br /> / s <br /> U <br /> Z T17. Transporter 1 Acknowled emeM of Ra[ei of Materials ' <br /> W R <br /> (� 61 <br /> A Primed/Typed Nomel, <br /> Sigrwbre(� MaMh Day Year <br /> wP <br /> O 78.Transporter—2 Acknowledgement of Receipt of Materials <br /> ty T Printed/Typed Name Signature Monts Day Year <br /> N19. Discrepancy Indication Space s "� <br /> Q F <br /> U A <br /> Z C <br /> L <br /> l 20. Facility Owner or O rotor Certification of receipt of hazardous materials covered by this manifest exce t as noted in It.. 19. <br /> T Printed/Typed Name II Signature Mardis Day Year <br /> DO NOT WRITE BELOW THIS LINE.^ <br /> DTSC 8022A (9/94) <br /> EPA 8700-22 White: TSDF RETAINS <br />