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State of California—Environmental Protection Agency L —CI _ <br /> Fonts Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back of -age 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12-pitch, Triter. Socromento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. ' 2. Page 1 Information in the shaded areas <br /> - WASTE MANIFEST <br /> C AL0001 .3].6 1 0771:'S of S is not required by Federal law. <br /> 3. Generator's Name and Mailing Address s_. A a .. (f f 1 t A. State Manifest of <br /> Number A <br /> 1.(39RCc S HARLAN RD 2251+70K <br /> o <br /> FRENCH C AMS` CA 95231-9600 B. State Generator's ID <br /> LO A. Generator's Phone (2091 9133-6970 <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> 6 SAFFTY—KL_EE19 SYSTEMS, I NC D. TranspoFteis Phone <br /> O eOri 669-5740 <br /> W 7. Transporter 2 Company Name 8. US EPA ID Number E. ;tate T.cpnsporter's ID[Reserved.] <br /> N <br /> QF. Transporter's Phone <br /> U DAS' t d Fgc'lity�! a an Sit Fs 10. US EPA ID Number G. State Facili 's ID <br /> IC <br /> 6000 06TH STREET <br /> 1)0SACRAMENTO CA 95828 CtA("✓00003451:' H. Faciliy'sPhone <br /> Q 12. Containers 13. Total 14. Unit <br /> ,y U 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol I. Waste Number <br /> Z a State <br /> F= }O , c fi w f y E <br /> E State <br /> co N b.co WASTE PAINT RELATED MATERIAL, 3 UN1263 212 <br /> co E PG 11 (ERG#128) 7. 2#/QAL.(F005. F'00 3, D001, DXP EPA/Other <br /> N R �1t 18, D035, D038, D03R, D040) Q 00 S-> F005 <br /> V A c <br /> 6 T :rate <br /> co O EPA/Other <br /> R <br /> State <br /> LU d. <br /> Z EPA/Other <br /> U <br /> LU <br /> N bona c t ton fo Mal rials Listed Above K. Handling Codes for Wastes Listed Above <br /> Z ) (fJ ? (? (A) D018D 35D0AD03t V039D040 y( b. i <br /> O F' I {G) 003 DOS?1 (R) D018, D035, ,�0P8, D0 3H, StsJO'tl,t1 <br /> 0 4 14 <br /> a <br /> LU <br /> C. d. <br /> J � <br /> Q <br /> 0C fE t blC(�45. ' s 6&j JQc � . VU ` c Tnspo21 Info r <br /> ti �1JbQ 24HRgon4g6nt <br /> a SK AUTHORIZED TO RETAIN LI.CE14SED SUESEGUENT CARRIER, AS NECESSARY. <br /> Z <br /> = A 12674 B RBOCs C: , D <br /> ., <br /> I& 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 /> Umarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> If I am a large quantity generator,I certify that I have o pr ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> o 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 generator,I have made o good faith effort to minimize my waste generation and select the best waste management method that is <br /> available to me and that I can afford. <br /> >_ ri e T Name g t Month Day Year <br /> U `- <br /> C7w T I7. Tfans orter 1 cknowled ement of Receipt of Materials <br /> R <br /> Cie in ame 7 Si ure Mont °y _ Ye°r� <br /> R 02 P ax <br /> U_ 0 18. Transporter 2 Aiknowled ement of Receipt of Materials <br /> O T Printed/Typed Name Signature Month Day Year <br /> w E <br /> N R <br /> Q <br /> U F 19, Discrepancy Indication Space <br /> z A \ 1 <br /> C 1 <br /> 1 � f <br /> f 20. FacilityOwner or Operator Ce ification of receipt of hosardous ma rials'oared by iNviriodilest exc t ai-iwtecl in Item 1 <br /> Tme /T No a Signature <br /> A d <br /> DO NO LOW THIS, N <br /> ' Yellow TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A(1/99) (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 /> EPA 8700-22 <br />