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State of California—Environmental Pro tion Agency <br /> For ., ved OMB No.2050-0039( spires 9-30-99) ' See Instructions.on back of page 6. Department of Toxic Substances Control <br /> Please print or pe. Form designed fa soon elite(12-pitch)typewriter. -e :,' `'�" Sacramento,California <br /> 1. Generatorage s US EPA ID No. Manifest Document No. 2. P 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS <br /> is not required by Federal law. <br /> WASTE MANIFEST L5 k LK of <br /> 3. Generator's Name and Mailing Address A. StateManiFest Document Number <br /> rE. ,:-F)C Z' : i-iRO1=-`trRTOSTATION <br /> �i G GAS AN 20255380 .1 <br /> o �7 kale Street r.24,a LJ A1101NI=P0-AD, U2 MILE=,sFEST,CR q <br /> LO A.. �a:ur;!� ( Al�106. LATIHR `i" C-A 953,`0 SfBfe Generators ID <br /> enerators one <br /> N 3� _ 7 t :7?4 :3.TTfls 1d..� �=n: t» 'r' -i t rpa r, � ? J <br /> N 5. Transporter 1 Company Name 6. US EPA IA mber C. State Transporter's ID[Reserved.] <br /> �^ 1 <br /> W 1 — :r- - t ("A L-:('aJ= <br /> p D. Transporter's Phone <br /> IC- .. <br /> o tG V 7 p G vt�7 c I A C' 9t i 3 u 3S 2 <br /> C? <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] <br /> CD F. Transporters Phone <br /> W Q <br /> V 9. Designated Facility Name and Site Address 10. US EPA ID Number G. Stat cil' 's ID l <br /> 7, 40 <br /> 11�Z ,;}i`{�ICAI -VVA TL M.�i�AGEa}._N ion <br /> (.�O ,,-52�' OLD SKYUNE f�/OAD H. Facility's Phone <br /> (y!2= i<: siA'i ^fT'vw'A :?t', T n t' 17 A t 7 !14 <br /> J <br /> C)V 11. US DOT Description(including Proper Shipping game,Hazard Class,and ID Number) <br /> 12. Containers 1 13. Total IA. Unit <br /> No. Type--] Quantity Wt/Vol L•WasieNumber <br /> N a. <br /> EE ON RORA HAZARDOUS' STE:`=OL 101 SCli:CONTAMINATED State <br /> �- ,h H-PRA CE E t , S) EP/�(Othor f# <br /> E <br /> N <br /> b. <br /> o <br /> co <br /> o <br /> cE rqt � <br /> v R E /Ot'fer rS 1141A K. <br /> i <br /> v A <br /> o T C. <br /> ,. <br /> o MANa0 O <br /> R dPATQf(s`erat'�r <br /> LU d. , ?r ri <br /> t— State �ij <br /> Z y k <br /> <br /> ER��ff�iat' <br /> <. f•s� Ott <br /> O J: n61 Ad( <br /> d t Descriptions r Materials istectAbove j E KK. Handfing',Cades gr,wosto., 41est,bbav{}F <br /> ^ <br /> Uj 41 <br /> Z <br /> O 15. Special Handling Instructions and Additional Information <br /> Q '�09ar PRE-gloves, goggles as appropri,aie24 HP contact# Lee ,Scares-F11n.i D Trans,R esei'}*tediAdo s_i�ils���'_1:11)0 <br /> Z EO#: 80a3036: Trait I POs#: .350,2— Tran 2 PO## <br /> Uj <br /> F- <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 economically <br /> Npracticable 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 m waste generation and select the best waste management method that is <br /> O available to me and that I can afford. t <br /> Z Printed/Typed Name Sign tur Mont / Days ar f <br /> [iLf <br /> w T 17. Transporter 1 Acknowledgement of Receipt of Materials / f <br /> LU R <br /> SignatMonth Day Year <br /> LU Printed/Typed Name _ ure�J / �' <br /> LU "s j`l('),(� .l l v 14-/Q IL c / f C, <br /> P <br /> LL- 018. Transporter 2 Acknowledgement of Receipt of Materials f <br /> 0 T Printed/Typed Name Signature Month Day Year <br /> LU E <br /> Q R <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> I <br /> L <br /> 1 20. Facility Owner K Operator Certification of Aecei t of hazardous materials covered by this manifest exae I as not8d in Item 19. <br /> T Printed/Typed ame Signature 1 Lvtonth t Dgy <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A(1/991 (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 /> V-c.rC� Alvq iD <br />