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State of California—Environmental Protection Agency %, - <br /> ro._ roved OMB No.2050-0039(Expires.9.30.99)'; See Instructions on back of Page 6. Department of Toxic Substances Control <br /> Please pr t or type. form designed for use on elite f 7 tch/ypewrifer. ...a. 4P,y -.Sacramento,California <br /> UNIFORM HAZARDOUS �If`,Generotor's US EPA ID No. Manifest Document No. 2. Page 1 Jnformatiap in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST :h ; x of <br /> 3. Gggnerptar�s Nptpe a d�laili��Ad n— >>T. T r A. State Manifest Document Number <br /> ti T%: ++=?iWit`-' t_i=�4,�:�.`.�AT:t�,f�•.�,'Ss,1 s:!. N 20255383 <br /> f Seale Sys t 824A UI 1`,� OA.y-, +i �!&EC 1"`_t'�� <br /> O <br /> San T at'. .p' 94106, <br /> B. State Generator's ID <br /> Ln 4. Generator's Phone(+�'tf ) 'mT�-3?._ A7_17�l: ^' `UQi!;?i3ti y� }y `y if Q' 6 0 s3 a <br /> N 5. jra1lsflortger 1 Com an Name 6. US EPA ID Number C. State Transporter's ID Reserved <br /> ?� ieP .i?ISI�C�PT ?t�,tti I*��'�sR;t°sr�RATLLf P �•1 <br /> D. Transporter's Phone <br /> O y w <br /> 00 7. Trans rter 2 Company N <br /> Po p Yame 8. US EPA ID Number E. Slate Transporter's 1D[Reserved.] <br /> 9QF. Transporter's Phone <br /> V 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> CHEMICAL WASTE,',JANA(32IhEKF INC <br /> )Z 3'6,`51 OLE)Ssc'��.NE POA0 <br /> +�� Facility's Phone <br /> _'� ET,1.�+..5 .'`� � `,-1 i Tr .x;13230 ,*�- ''r �i l� 1 ? 7 - !2} +�t'3t'?,,,tj, <br /> )V 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 1.2• Containers 13. Total ld. Unit <br /> N6. a pe Quantity Wt/Vol 1. Waste-Number <br /> NZ a.tA 'd ' i."t}� 7!'.;i�i:Lt i:� '�`, v`C:v;JL3�l 'L_t1;,sT4;tA114, .ICL1 'v State <br /> 3 Gv e �j :1 lj �, '3 { EP /Othe7� <br /> E v. ./'(� r t+i <br /> c1iN ` b. <br /> O State <br /> co <br /> cioo E ~ <br /> .7 R EPA/Other •- <br /> C14 A <br /> o T <br /> State � <br /> 00 O <br /> R / .r EPA/Other 5 <br /> Ine <br /> LU d State r: <br /> ZUj <br /> w _....i <br /> VI EPA/Other <br /> Uj <br /> ZJ. Additional Descriptions for Materials Cited Above K. Handling;Codes:ForWestes Listed Above 1 <br /> o: <br /> W 73JA:9F4M1 d%+']..:L A�F;'`ntHtlP t'tsT DWITH.•.TRACE!A?ZrA -9 I..FSQ.r 171; <br /> C. d. <br /> QJ J'/ <br /> t <br /> Z 15.yS (,H kin r ti ;and F' I�nF�rtp t,' <br /> 0 � ads as '1t`s�$� y, g �r33�t!`�op-,trie2 HR coritad# Lee Sioaresi- R,41ms,i rans FieemadiatiSun+ <br /> LU <br /> J 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name'-arid are classified,packed, <br /> Q marked,and labeled,and are in all respects in pr6per 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 presenYand Future threat to human health <br /> and the environment;OR,if I am a small quantity generator;l have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> Oavailable to me and that I can afford. <br /> } Prim-(Tygey{Nan�e, Si net 1 Mont Days Year <br /> 14101 Z �Tti�i L ts71 <br /> T17. Trans orter 1 Acknowled emen <br /> R ecej f of Materials <br /> �j p Printed/T ed Name Si fare'" Month Da� Year <br /> W P1, ' .J ,...--- - y l t� <br /> LL 8 18. Travis p orter 2 Acknowle a ent o Recei t of Material?; l ' <br /> T Printed/Typed Name Signature Month Day Year <br /> LU E <br /> < R <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> — A <br /> C <br /> I <br /> L <br /> f 20. FacilityOwner or Operator Certification of recei of hazardous materials covered by this manifest except as noted in Item 19. <br /> j Pri?teC//Typed Name Signator Montb a <br /> j y 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 />