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— — — - -- - <br /> � <br /> Siote of Caiifogle—Environmental Protection Agencyw� <br /> Form Approved OMB No.2050-0039 IExpires 9-30.991 See Instructions on back of pa' 'S. Department of Toxic Substances Control <br /> Pleasbprint ortype. Form designed For use on elite f i'2•pitchf type. Il - Sacramento,CoGfornia <br /> 1. Generates"US EPA 1D No. Manifest Document No. 2. Page I Information in the shaded areas <br /> UNIFORM HAZARDOUS <br /> s not required by Federal law. <br /> WASTE MANIFEST —7 ' of <br /> 3. Generator's Nome and Mailing Address1Aans umber'" <br /> 936IT <br /> t <br /> `JA <br /> (� T SkdsGeneiokssf s tD. GenErof r- s�hane. Transporter 1 Company Name 6. US EPA ID Number C 51vteimiipoAer sJD 1''^s" t� '� s <br /> OJ D Tss�vsiss. �hmse �; ` <br /> r <br /> 7. Transporter 2 CompanyN8. S EPA ID Nu'mbe`r E..State TrasispessaCs.l _, int f _ <br /> Q <br /> 'V 9. Designated Facility Name and Site Address 10, US EPA ID Number <br /> Q m eve "_.1 u:, r v �Yt <br /> � .'t � 7(,} �f s.y� .� Q :> FL factlsiy s:Phase �, "'' ,,h �•,fr `f+se`�s : <br /> 12 <br /> V 1 1. S DOT D <br /> ontaasers 13 To ld. Unit <br /> Uescription mduding Proper Shipping Name,Hazard Class,and ID Numberl No'r Type Quantity Wt/vol ,Wcsiw`fNumber Vy.., <br /> Z a. S!a!a <br /> 5 LJ <br /> I Ca j EPA/other <br /> s E � /� f a r ! f t � r, t —T`- Fy •1 tiY} - <br /> I <br /> t'4 N b. State <br /> coCN <br /> E EPAYC?ther <br /> o f <br /> CO ;EPA/Other <br /> w d. 'Statue-- - <br /> 71 <br /> Lu <br /> EPA/Other <br /> W I I 1 <br /> Frm <br /> 1. Additional Descriptions for Materials Listed Above �s t %K. Handling Codes for Wastes Listed Above <br /> 'a. b. <br /> Z{ <br /> Q I 15. Special Handling instructions ondAdditioipl Informat7an� j <br /> QI i <br /> Z � k <br /> r, <br /> 16. GENERATOR'S CERTIFICATION:-I hereby declare that the contents of this c5niignment are Cully and dc¢ur,;iely described above by proper shipng home and are clossiked,packed, <br /> Gmarked,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 certi'ry that have a program in piai:e to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> O ' <br /> i practicable and that I r ove selected the practicable method or treatment,storage,or disposal currently available to me which minimizes the present and future threat to human heahh i <br /> and the environment; R, if I am a smoll ouantity generator,!have made a good faith effort to minimize my waste generation and select the best waste manogement method that is <br /> nvaiiable TO me and that I can afford. <br /> } Printed/Typed Npsoe/ / Signature Month Day Year <br /> u T 17. Transport*" Acknowiedoemer�r of Receipt of Mafariais <br /> A Printed/Typed Name Signature Monrfh Day Year l <br /> P <br /> U 0 18. Transporter 2 4cknowtEeement of Receipt of Maleriais <br /> 0 T Printed/Typed Name Signature Month Day Year <br /> "SIR I I I <br /> U ! l9. Discreponcy IndicotLon Soace <br /> �I F I <br /> =7 -A i ._ .:.- .-. I <br /> � I <br /> 20. Facili_ry Owner or Ooeraror C_er0rcar;on of receipt of hazardous materials covered_ by this manifesr excear os noted in Item 19 - <br /> ?rired/TYPed Name Signature <br /> Month Day Year <br /> I f I I <br /> DO NOT WRITE BELOW THIS LJNE. <br /> I DTSC 8022A I4/971 <br /> EPA 3700-22 car - <br /> III <br />