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State of California—Environmental Protection Agency ' <br /> Form Approved OMB No.2050-0039(Expires 9-30-99) See Instructions On back OE nage 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12-pik writer. Sacramento,California <br /> UNIFORM HAZARDOUS I Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST of 1. is not required by Federal law. <br /> 3. Gsn r tor's Name an�Mailin Address A. State Manifest Document Number <br /> 1 t:: It j 22196564_ <br /> B. State Generator's ID <br /> h 4. Generator's Phone(24-`T) <br /> N S. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved] <br /> a7 ..h itit w ^•;i i F�1 r;1 s'� J T-'['!.�' <br /> 1 `. -_.. <br /> � t D. Transporter's Phone <br /> p 'S'.10 <br /> CD F. <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID(Reserved.] <br /> QF. Transporter's Phone <br /> 1I U A.•., ql F an te.A a 10. US EPA ID Number G. State,Facility's IP <br /> CG r '? <br /> t,A,'. R AN ENT'3 A +::a-'_ta _,.. H. Facility's Phone <br /> N Q12. Containers 13. Total 14. Unit <br /> V 11. US DOnT Description(including ProX t..per Shipping Name,Hazard Class,and ID Number) / No. Type Quantity Wt/Vo I. Waste Number. <br /> _ _^a. ?t't1 tr.$,ap sE11C'IN f. !�7 .���-� /''� late <br /> 3 G ±.t ;. DOs Ll. o'.) ifi F'�='#x� t.. er l . <br /> EState <br /> Y .c. <br /> co rE� :31Nry]12b7,.';^� PC �6• 1 i (JE�'!g#J z.:/Y� 7 'a: L%�C; EPA/Other ♦ _ <br /> R ,fi•'*05 003 D00.$P011.E�t�'_+ 1)03 i•1)7�}'i f_t <br /> A c. State <br /> o T <br /> co O <br /> R - EPA/Other <br /> Lu d. State <br /> Z <br /> w> <br /> lEPA/Other <br /> Lu <br /> V) A Ilion A on c, t reals Liyt d Abo K. Handling Codes For Wastes Listed Above <br /> L <br /> w <br /> ck� c. d. <br /> J <br /> Q <br /> ~Q Cc AfJItT]0 `L ZCL' TQ. RETAIN <br /> k.. ' 'AI'ti� •�� C"�.: j' <br /> ZLu <br /> '� r <br /> H <br /> 16. 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 /> 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 /> 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 economicall <br /> qy <br /> d practicable and that I 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 /> 0 <br /> available to me and that I can afford. <br /> � �t d ame ,,.1vO �� Sin f Month. Day, Year <br /> Z 'r <br /> MW <br /> w T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> A <br /> w p Prin ped Name _ � Signature��� _sf � '. Month_- Day Year <br /> w <br /> a <br /> w0 18. Transporter 2 Ackn wled ement of Receipt of Materials <br /> ° T d ed Name' \ r _ Signature Month Day Year <br /> Lu E j <br /> N A <br /> lJ 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month._, Day Year <br /> r' <br /> Y ` <br /> DO NOT WRITE BELOW THIS LINE. s e • <br /> t <br /> DTSC 8022A (1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />