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Siote of California—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9-30-99) <br />Pl9as6 print or type. Fofrs desigled for use on elite 02-1t.—;t- <br />CN 12- aewriter <br />0 <br />N <br />'n <br />W <br />0 <br />� m <br />Q <br />A') V <br />VQ <br />nZ <br />Jr o <br />�} v <br />Z <br />3 G <br />E <br />o N <br />66 <br />66 E <br />-4 R <br />v A <br />See Instructions on back of 6. <br />De—irn.nt of T.,,.:, <br />M HAZARDOUS I Generator's US EPA ID No. Manifest Document No. 2. Page I <br />Sacramento, California <br />Informotion in the shaded <br />E MANIFEST <br />T 17. Trans orter 1 Acknowled ement of Recai <br />A <br />areas <br />is not required by Federal law. <br />9 <br />F(G-enerator's <br />P <br />me nd Mailing Address <br />C, D 3 E (-('152U) <br />A. State Me lifesl Document Number <br />T Printed/Typed Name <br />w <br />V) <br />,Su' 100 C Cgy A ve • I � p r `5 b A Ci, A q 20o <br />4. Generators <br />B. Slab Generator's 1D <br />Phone (� ) /z <br />19. Discrepancy Indication Space <br />5. Transporter 1 Company Name 6, US EPA ID Number <br />C Stale Tronsporfer's ID [Reserved,] <br />AS"Y ENVIRONMENTAL SERVICES <br />F P P F 7 <br />Q 6 ID. rcansportera Phone <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. Stale Transporter sID IReserved.} <br />Y <br />Fs:itansPbrlM'� ftFrasr. . <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />D / K - EaWRONWENTAL <br />G. Sto A <br />3860 EAST 28TH STREET <br />LOS ANGLES CA GM <br />H, F*;16 <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers 13. Total <br />14. Unit <br />a. <br />WASTE HYPOCIFLORJTE SOLUTION, e, Lmni, <br />No. Ty a Quantity <br />Wt/Vol L Waste Number <br />PO lit <br />r <br />b. <br />/ <br />MMK' <br />state <br />C, <br />EPA/Other ' <br />o T K ENVI ONME TAL FACILITY IN LOS sfaro <br />0 <br />6r <br />R N E E C LIF R I HAS TH EPA/ Oth;r - <br />LU d. <br />Z ASTE S REAM S QUALIFIED OUR E <br />W <br />tli <br />U R IS AT 8 0 6 1 epa�otlar <br />rn J. Additional Descriptions for otenaIs lei ` ave <br />K Handl n$ Codes for Wastes listed A�ove <br />0 11Aj 94E>1716.10, G AW STATE OM 141 a. -:,. — b <br />N <br />p 15. Sp4ciol Handling Instructions and Additional Information <br />USE PPE EkERGENCY CONTACT :CFEMMEC 1-ODD-424�9C w <br />Z NAERQ # 11A 164 <br />ru <br />5 i Ari - 2tie. f'\�`'�' `f ri <br />..r 16. GENERATOR'S CER ATION: I hereby decla a that the con tenh of this consignment are tatty ond accurately described above by proper shipping name and are 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 />v <br />J IF I om a large q.that IT generator, 1 certify that I have a proram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be "Onoreica11 <br />�- practicable and that I hove selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health <br />and the environment; OR, if I am a small quantity <br />Qavailable to me and that I can afford. 9 ty generator, I have made a good faith eft«t to minimize my waste generation and select rhe best waste management method that is <br />} Printed/Typed Name $ignatur <br />U / • . A <br />Z <br />W <br />0 <br />T 17. Trans orter 1 Acknowled ement of Recai <br />A <br />w <br />W <br />A Pr' ted/,sped Nom e <br />s <br />P <br />sa_ <br />R 18. Tram rter 2 Acknowled ement of Recei <br />T Printed/Typed Name <br />w <br />V) <br />E <br />R <br />VIF <br />19. Discrepancy Indication Space <br />A <br />C <br />I <br />20, Facility Owner or O rotor Certification of <br />T Printed/Typed Nome <br />Y <br />DTSC 8022A 11/99( <br />EPA 8700-22 <br />I Signature <br />Month Day Year <br />�L-=, J-, 1 1. 1 <br />!� AUG 2 5 2004 �J <br />izardous materials covered b this manifest exce t as noted�11*m <br />Signature ... �� .e <br />��711Ct11R' � Day Year <br />'_---- Z <br />DO NOT WRITE BELOW THIS LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />(Generators who submit hazardous waste for transport out-of-state, <br />produce completed copy of this copy and send to DTSC within 30 days.( <br />