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-1--l-ientai rroteoton Agency <br /> FoAft'Appr.wdOMB No.2050-0039(Expires 9.30.99) See Instructions on back Of <br /> -9e 6' <br /> Please print or type. Form designed for use on elite(I 2-pitch vriter. Department of Toxic Substances Control <br /> Sacramento,California <br /> UNIFORM HAZARDOUS generator's Us EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST is not required by Federal low. <br /> 3. Generator's Name and Mailing A4dress A. State Manifest Document Number <br /> �P� Lk V.,f�( 98067987 <br /> �r �' / i(t C f T✓� S. State Generator's ID <br /> h 4. Generator's Phone <br /> CV 5. Transporter 1 Comppny Nome um <br /> r 6. US EPA ID Number h 1 C. State Tran er't ID <br /> ap ``���•.�. -' � �.yi l: f c Won <br /> Phpoe <br /> .•rt.c r 1;4 1) ( U 1 h (' / D:.Transporte/s <br /> 7. Transporter 2 Company Name <br /> p° F y 8. US EPA ID Number Irptp TronsparterI4 <br /> J <br /> J L r <br /> rye 9. Designated Facility Name and Site AddSess 10. U�EPA 10.Number <br /> M/ C N e a t'C t+L r•. �}r r�. .:., Fi :eMt �! '�' I' ''t`� <br /> tO 1 lit focififyrs Phone <br /> O V 1 1. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12• Containers 13. Total 14. Unit <br /> MZ a No. Type Quantity Wt/Vol 1. Waste Number <br /> t � f� .:�'•;f� <br /> State. �� <br /> F <br /> E , F y EPA/outer <br /> Go E State <br /> 0 A EPA/Other <br /> o Tc. <br /> coo O �Ot° <br /> oe <br /> R EPA/Other <br /> W d .. <br /> t- <br /> Z State' . <br /> W <br /> U <br /> EPA/Qther <br /> cavallal Destxj;ZW�s For Moferus{s UstOd Agave <br /> Ii Codes Fdr•Wa:te:iisfed Above <br /> LLj <br /> 0 15. Special Handling Instructions and Additional Information <br /> JA o <br /> L z- <br /> Q16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> U marked,and labeled,and are in all respects in proper condition For transport by highway according ro applicable international and national government regulations. <br /> J <br /> hJ 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 hove determined to be economically <br /> practicable and that 1 have 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 generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> O available to me and that I can afford. <br /> U Printed/yped Name , <br /> Signature Month Day Year <br /> Z it✓, i J-�!���/NX11 < ter' // '''' 64--- ice' /. ✓ <br /> O % <br /> W f <br /> T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> sPrinted/Typed Name Signature t Month Day <br /> 0 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> T Printed/Typed Name <br /> NE Signature Month Day Year <br /> Q R <br /> U F 19. Discrepancy Indication Space <br /> Z A <br /> C <br /> I <br /> L <br /> 20. Facili Qsvner or Operator Certification-of receipt of hazardous materials covered by this manifest except as noted in Item T 9. <br /> T Printed/Typed Name 1 Signature Month Day Year <br /> `. .r S/; <br /> r •� b\ �)DF qOfT WR4T�BkLgW THIS LINE. <br /> DTSC 8022A (4/97) <br /> EPA 8700-22 Yellow: GENERATOR RETAINS <br />