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r <br /> State of Califomim—Environmemd Promotion Agenry -- <br /> Faan Approved OMB No.2050-0039(Expires 9-30-94) SDs Instructions on bask v age 6. Deportmmn of Toxic Substances Cann <br /> Please print or"p Form designed for use on elite Sacramento,C.1i omm <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Monde*Decumerd No. 2. Page I Information w the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST _ / ^ O i n �, r ? < (/ of, <br /> i <br /> 3. Generator's No.and Mailing Address t•kr be <br /> 0 9"5028 <br /> —_ <br /> S. AIIPiRT .:,kYI oTO- ;,,rrI 'A SUL:i'_ cmeawrxlD <br /> tij 4. Generator's Phone CC r• ) ,•^ —" �_" ! � i <br /> S. Transporter 1 Comparq Nome 6. US EPA ID Number m isampartx's ID <br /> op <br /> s.u4 i..vst.t..,1.\L •'E..ur c:.Y .:G.(I. I sn :1 a1 z"7-7277 <br /> 7. Transporter 2 Company None 8. US EPA ID Nswber <br /> U mere Phune <br /> 9. Designated Facility Name arel Sib Address 10. US EPA ID Naber Fadhfy's ID <br /> .S.,f; YOo O Jh ePhano � . ; _I <br /> -L v.a, <br /> - m ^ ' <br /> 1 Cl 31 Oil <br /> ITTY <br /> Lf) 11. US DOT Description(including Proper Shipping Name,hazard Class,and ID Number) Comainers 13. Total 14. Unit <br /> Z Na.NoI Ty,x, Q.-ntity vAlval •Waste Number <br /> 00 <br /> N3 ::ALTE '` ttp� <br /> O E IUii dl• rs �l..A%.iUU tsJTL JULi.r, L i; qr ( $ P ;AnVtli. <br /> m N b. <br /> ao E <br /> RA/other <br /> A <br /> T C. <br /> e m O <br /> R 'A{Other <br /> d. - <br /> us <br /> V <br /> W <br /> A/Other its <br /> N <br /> Q dbbnal Descriptioter <br /> ns for Maials listed ' " ing('ades for Wasim Listed Above ,- <br /> b. '. <br /> d...r,l, <br /> a <br /> 0 1s. Spacial lio,tdp,g itbn,rcNarr anal AddNotml kdannolian ._.. <br /> a USC PROPE;) AFL TY LiUIP;iEi:T '.ILL T": --%V1PMCiE1+TA-L RECOVERY JE VICEi; <br /> Z "!LRC 1,LY CC'.iTn-T - r crTi _ '.- GO-'^'-- 30C E;;EIGujCY aUIDE 31 <br /> W <br /> H <br /> j 16. DINERATOR'S CERTIFICATION: I hereby declare that the conbms of the consignment aro fully and am,ralely described above by proper shipping name and are classified, <br /> a packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international laws. <br /> U <br /> If I am a large quantity generator, I certify thm I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> Q. economically practicable and that I hove selected the practicable method of treatment, ts storage,or disposal currently available to me which minimizes the present and future <br /> N threat to human health and the envirormem;OR,if 1 am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> K waste management method that;s guidable to me and that I can afford. <br /> O Printed/Typed Nome Signature Momh Day Isar ' <br /> Z T 17. Transporter 1 Acknawled of Remi of Materials - <br /> W N rimed/Typed Name I SigmMath Day ey <br /> wR 18. Transporter 2 Acknowledgement of Receipt of Materials - <br /> W e PnT to pi d Name Sigmre tuDay Year <br /> O • ...•at <br /> " 19. Discrepancy Indication SpaceIs JAN 2 5 1995 <br /> U A <br /> Z C <br /> 1 NMENTAL HEALTH <br /> wner <br /> 1 20. Facil' Oor rata,Certification of receipt overe <br /> i t of hazardous materials cd this manifest ex rn noted in Nem <br /> T Prinhd/Typed Nome Signature Momh Doy Year <br /> Y <br /> DO NOT WRITE BELOW THIS UNE. <br /> DTSC 8022A (7/92) <br /> EPA 8700-22 <br /> EPA 8700-22 <br />