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State of California—Environmental Protection Agency <br /> Form, •_ oved OMB No.2050-0039(Expires 9-30.99) See Instructions On back Of page 6. Department of Toxic Substances Control <br /> Please prin o type. form designed for use on eli (12-pitch)typewriter. Sacramento,California <br /> UNIFORM HAZARDS 1. 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 " _ _ ., L } of 1 <br /> 3. Generator'Name and MailiTg Address l v <br /> Y .t r'Iti A J AND_LEC-TRIC <br /> r-E ^�' ^ = A. State Manifest Document Number <br /> Sr-E 20255386 <br /> . <br /> T7 Beve vtr"t b24A 1 # Iii Fs AD 112 3s1'ILE AES,vlw�. ­X=R <br /> O S:art Fran Osco CA}�i LTJ �s1;t�.,-f�'�rf vh �,�<'� B. State Generator's ID <br /> LO 4. Generators Phone(4';S <br /> � ) -973-33771,3 TYtGober,Gv a f 1 a I j r0l Y :'3: 's <br /> N 5. Transporter 1 Company Name 66..�Ut-S'EPA ID Number C. State Transporter's ID(Reserved.] <br /> o D. Transporter's Phone A n t F (8M)23& <br /> 1477 <br /> 00 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID(Reserved.] <br /> LOJ F. Transporter's Phone <br /> 00 Q <br /> V 9. Designated Facility Name and Site Address 10. US EPA ID Number G, a oei��D <br /> �Q r`rtEM1. '�� E MANAGEMENT.INC <br /> `n� - 251 �'I�t KY1_'NE POAD • . <br /> ^^ r��•� H. Facility's Phone. <br /> V O KEE-77S SMAUN'' C'7'r-A 932238 = A T +� 1's i, F ' 118 <br /> 3 t <br /> Q12. Containers 13. Total 14. Unit <br /> V.!U 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol f_-Waste Number <br /> y Z a NON T1, A HAZAREDOW5 VVAS t. SOLIG(5')iL �l,A, HNAt 1 EL <br /> 4,: <br /> O N <br /> m E <i � rfi? fi <br /> o T C. 5tateyy I y �ti <br /> m O <br /> R Ew?�Otbef S ?tits <br /> LUd. <br /> u <br /> Z ; <br /> LU <br /> U �`% Etkifflibe4; � „` <br /> LU <br /> ZAd AK nal Descriptions for Mat ials Listed Above K. Handling Co For Wastes fisted AfwVet t: tyi <br /> j 5A: 4M WLC'O T KAM"Arlt4 TRACE METALSS E!RG 1 <br /> Q ass w v <br /> 0 15.,,S Fltlpd�ing Instr c{ions and Additional Information <br /> *��� rr at sus, es as appropr..ate24 H. cmrAad#0 _wee .-oares-until TranS_Reetr,C?d1abor1 t-c;t_�-,t,- 1 J3C <br /> zf� �: �>]; Tran 7 : 31:1x: Trac <br /> LU <br /> Ji 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment shipping name and are classified,packed, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> -J-+ If I am a large quantiy 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 /> 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 /> N and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my wast eneration and select the best waste management method that is <br /> 9X available to me and that I can afford. <br /> 0 r <br /> ZPri'tidC50 p t-raj Sign e f Mon tfp rt Da Yea <br /> ty T 17. Transporter 1 Acknowledgement oLg.ecei t of Materials i {v� 171 / /vl <br /> c7 R <br /> 09:p Prinle ed Name ,j• { Signature �_ 7 �^Mon/t Days, ea,f <br /> LU S <br /> U_ 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> 0 T Printed/Typed Name Signature Month Day Year <br /> LU E <br /> N R <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> 1 <br /> L <br /> 20. Facility Owner"or Operator Certificationlof receipt of hazardous materials covered by this manifest exce t noted in Item 19- <br /> T Printed/TypedNN�pp��rr\ep ,�f',"ttk <br /> Y, <br /> C Signatur o h f D4 a 1 <br /> i � ) I <br /> DO NOT WRITE BELOW THIS LINE. a }! <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 thi' copy and send to DISC within 30 days.) <br /> 4h7!/h Qr' <br />