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State of California—Environmental Protection Agency ct'/Zf 10 - <br /> Forrlr>T„oved OMB No.2050-0039(Expires 9-30-99) See Instructions on back of page 6. <br /> P 9 Department of Toxic Substances Control <br /> Please print a pe. Form designed for use on elite t12-pitch)typewriter. Sacramento,California <br /> Y <br /> UNIFORM HAZARDOUS # I. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST h - r J <br /> of <br /> OEHYDPATF STA <br /> 3. er�'s ev I' dr1(� ��T•r-. Y- — A. State Manifest Document Number 20255379 <br /> '?Beaje Snot 824A. UN*1jl aE POA v. i f2 W! E,r.E^r rc;:C EP - <br /> O gal,'•-m1dsc" A 9418.5 i_4 '�'�. 13,0 B. State Generator's ID <br /> LO Y <br /> LO A. Generator's Phone j -973-3773 :A,71114- Robert <br /> N <br /> N 5. �r IIGo OPPOFA 4.T115 EPA ID Number C. State Transporter's ID Reserved.] <br /> oma. <br /> EZLJ <br /> CP <br /> O r. ,L = D. Transporter's Phone + LJ93-'.'_1 y s- <br /> O <br /> ao 7. Transporter 2 Company Name B. US EPA ID Number E. State Transporter's ID Reserved.] <br /> !�J <br /> Q F. Transporter's Phone <br /> ^U 9. Designated Facility Name and Site Address 10. US EPA ID Number G.Site Facility s ID oe <br /> .c C !EMICA.L'ra,ASTc MANAGEMENT'MIC-16 <br /> KETTLEkIANI 171CA 93239 i, 3 T 1j f1 a ��4 6 1 H. Facility's Phone � d <br /> i� <br /> �U 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> s n, i. ;;s .r•.. �„ No. Type Quantity Wt/Vol 1. Waste Number <br /> Z a vs -stirs : .r .v�v,a ...,;_:....~,.-ua.t a �a.�~...sTn�.s •ani Sfat'e - <br /> 3 G ., 12 z I- � � l y� E ��e�.r l�s�► <br /> E <br /> o N b' ? State <br /> o`ao E <br /> a R �RA/Other <br /> v A <br /> o T C. <br /> $fate <br /> a0o O i <br /> R EPA/.Other <br /> LU d. S'}afe <br /> Z '� <br /> W <br /> U \ EPAfOther <br /> w _ ? <br /> V) J. Additional DescKptlons for Materials Li;ted Above K. Handling Codes for Wastes Lilted Above <br /> 71 1 <br /> r FA:€F499'SD]k..(s"f�3T,�?�I�'�t 1�o'3TH TIRACI!MeiTFj,E.wS- ERG-171. <br /> LU <br /> f e <br /> C. d <br /> Z 15.';Seeti„gfF]a'42 gingst}I[F}jatssa mral �49a{ ir$T!+ ate" HR -'r`onta:_# - L a aa<_- 3.1 #Y.^g ?��i$d. i3;511f11 -i�� -.'21 N-+ <br /> `�J t— 8019 Yr r.7 > f+r P''f' es Fs-«,.. 3.%t•s� , i1 r <br /> ~ 'C-#. 8063 X32; ,?ran. •1 PCW: .3�L, Tran 2 PC�: - <br /> ,_ <br /> 16. GEN ERATOR',VCERTIFICATION: 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 irlabeled,and are in all respects in proper condition for transport by highway according to applicable international and nationol government regulations. <br /> If I am a large quantity generator,I certify that I have a pro ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> 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 /> available to me and that I can afford. <br /> O <br /> } Prin Kame.; ign re (('''` Montthh� Dayyy JY�ear <br /> Z 11 1/ <br /> w T 17. TransporterAcknowledgementceoaeras )i. <br /> C� R Tt1 kecitf Materials <br /> � v <br /> w N yped Name <br /> Signet rel' Month Day ear ! <br /> w S 1 I� `.� y <br /> u 0 1 rens orter c ncwleclement of Wceiptlof Materials ( f <br /> 0 T Printed/Typed Name Signature Month Day Year <br /> LU E <br /> Q R <br /> U 19. Discrepancy Indication Space <br /> Z IF <br /> A <br /> C <br /> L ,... <br /> 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,,--_ - l Month Da Year <br /> DO NOT WRITE BELOW THIS LINE. <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 /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />