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Stale of Cali fornia—Environmenlal Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9-30.99( See Instructions on back of pa i. Department of Toxic Substances Control <br />Please print or type. Form designed for use on elite (12 -pitch) typewriter. Sacramento, California <br />0 <br />N <br />n <br />CV <br />h <br />0 <br />0 <br />00 <br />II <br />�J <br />Q <br />Lou <br />ar <br />LL <br />t- <br />2 <br />L <br />LL <br />V <br />2 <br />C <br />ckv <br />a <br />2 <br />t - <br />U <br />L <br />a <br />l <br />u <br />L <br />L <br />L <br />l <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />DO NOT WRITE BELOW THIS LINE. <br />White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />To P.O. Box 3000, Sacramento, CA 95812 <br />I. Generator's US EPA ID No. Manifest Document No <br />2. Page 1 Information in the shaded areas <br />UNIFORM HAZARDOUS <br />is not required by Federal low. <br />WASTE MANIFEST <br />AlL v' Q O g Q1,3 9, 2 5 5 <br />all I # <br />3. Generator's Nome a d Mailing Address <br />—,a► -9.f,+ C, �0 3E CTI52.0 <br />A. State Manifest Document Number <br />23592552 <br />1 � 05 As+vn Ave ., SU 4e- 100, ('a rl s b ad, CA q 200 q <br />B. Stale Generator's ID <br />4. Generator's Phone ( I-1 q <br />5. Tronsoorter 1 Company Nome 6. US EPA ID Number <br />C. State Transporter's ID (Reserved.? <br />ASBURY ENVIRONMENTAL SERVICES ICAD 10 12 18 12 17 17 10 13 16 <br />D. Transporter's Phone 000)974-44% <br />O �fYJJ <br />7. Transporter 2 Company Name S. US EPA ID Number <br />E. Stale Transporter's ID (Reserved.)) <br />F. Transporter's Phone <br />9. Designated Faci ,Oy Name and Site Address 10. US EPA ID Number <br />G. Stat 's ID <br />D ! K - EMIRONMENTAL <br />0 <br />H. Facility's Phone <br />3650 EAST 26TH STREET <br />LOS ANGELES CA 000 9 0 0 3 3 6 8 1 <br />(323)268-5456 <br />12. Containers <br />13. Total <br />1 d Unit <br />I 1 US DOT Description [including Proper Shippirg Name, Hazard Class, and ID Number) <br />No. Type <br />Ouantiry <br />VA/Vol <br />I. Waste Number <br />a.I <br />WASTE HYPOCHLORITE SOLUTION, 8, UN1791, PG III <br />State 122 <br />iEPA/Other <br />G <br />0002 <br />Eb <br />State <br />EPA/Other <br />E <br />R <br />State <br />T <br />C. <br />EPA/Other <br />O <br />R <br />I <br />d <br />State <br />f <br />jEPA/Other <br />). Additional Descriptions for atenols Listed Above K. Handling Codes for Wastes <br />G STATE CODE 141 I ° <br />Listed Above <br />b. <br />11A) 340715-10,X ADD <br />i O t <br />�o <br />1 Spe ial Handling Instructions and Additional Information <br />USE PPE EMERGENCY CONTACT :CHEMTREC 1-800-424300 <br />NAERG # 11A 154 <br />S i k ' ar - 2 1� <br />16 GENERATOR'S CERTIi ATION: I hereby cleclar'lls that the contests of this consignment re fully and accurately described above by proper sh pring name and are classified, packed, <br />by highway to applicable international and notional government regulations. <br />i <br />marked, and labeled, and are in oil respects in proper condition for transport according <br />i <br />large I certify that have a progrom in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br />health <br />If I am a quantity generator, <br />procKcable and that I nave selected the practicable method of treatment,. storage, or disposal currently available to me which minimizes the present and future threat to human <br />faith to minimize my waste generation and select the best waste management method that is <br />end the environment; OR, IF I am °small quantity generator, I have made a good effort <br />cvoilable to me and that I car oFord. <br />Printed/Typed Nome Signatur <br />Month Day Year <br />lJ <br />T <br />17 irons orter I Acknowledgement of Receipt of Materials <br />Da Year <br />RMonth <br />RA <br />J N <br />Pri t d/ ped Name r� Signature <br />,AVI - (� <br />nal <br />t S <br />P <br />1/ <br />0 <br />18. Trans rter 2 Acknowled ement of Recei t of Materials <br />Month Day Year <br />TPrinted/Typed <br />Name Signatur <br />E <br />R <br />j19. <br />Discrepancy Indication Space <br />F <br />a A <br />C <br />1 <br />L <br />I <br />20. FacilityOwner or Operator Certif�cahor of receipt of hazardous materials covered b this manifest except as noted in Item 19. <br />Month Day <br />T <br />Y <br />_ 4Year <br />Printed /Typed Name �� Signature <br />e r r �' ZZ <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />DO NOT WRITE BELOW THIS LINE. <br />White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />To P.O. Box 3000, Sacramento, CA 95812 <br />