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State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back of nage 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite 112-pitcf -iter. Sacramento,California <br /> UNIFORM HAZARDOUS - aerator's US EPA ID No. Manifest Document ._ 2. Page 1 Information in the shaded areas <br /> snot required by Federal law. <br /> WASTE MANIFEST C A 6 1181 O O 9 1 LJ1P)11 1 of 1 <br /> 3. Generator's Name and Mailing Address X.7Stare Manifest Document Number <br /> U.S. POSTAL SERVICF - PW ��W� �2'8 7 <br /> 3131 ARCH MWrtOAD B. State Generator's ID <br /> r. <br /> 4 Ge17goo/5"��on9S�l1 <br /> N 5. Transporter 1 Company Nome 6. US EPA ID Number C. State Transporter's ID(Reserved.( <br /> V) <br /> oD <br /> o <br /> RMC EMYI TAL TECH. Ci A 9 s '� D Transporter's Phone 1651)1324'1638 <br /> 0 <br /> ao <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] <br /> F. Transporter's Phone <br /> t U 9.�Designated Facility Name and Site Address 10. US EPA ID Number G- State Facility's ID <br />� C JA ID1 0101 91 41 5 <br /> NZ RNIC EHYIROt�f!£IiTAL TECH <br />�0 ,t WI BAY ROAD C A D O 0 9 4 5 2 H. Facility's Phone 16541324-1638 <br /> WrrJ <br /> 12. Containers 13. Total 14. Uno <br /> LnU 11, US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number] No. Type Quantity Wt/Vol I. Waste Number <br /> _ BATTERIES, DRY CORTAIIIIHG POTASSIUM HYDR011DE SOLID _ State <br /> 6 LW3028 III 7 c G <br /> � r <br /> ~ EPA/Other <br /> 3 <br /> E <br /> o N b. BACiE:SIES, WE1', FILLED WITH AUALI 8 UK2795 III state IMF <br /> 6605 E �vv '� 121 <br /> -4 R / EPA/Other <br /> N P.RGI 14 <br /> A <br /> O T. cMOAI'RCRA HMRM VASTE, LIQJIU State <br /> 00 O (EiTHYL�E GLYCOL,UP) 135 <br /> R Prf EPA/Other NONE <br /> LU d. IA-RCRA HAZARDM VLM, SOLID I C"$' State <br /> t— <br /> w iDEIIRI�I�iF'RUPAyi1L1 <br /> U EPA/Other <br /> U.1 1� <br /> Z J. Additional Descriptions for Materials Listed Above K Handling Codes for Wastes Listed Above <br /> 0 a. b. <br /> L I <br /> V) D <br /> LU <br /> C. d. <br /> J <br /> Z t <br /> 0 15. Special Handling Instructions and Additional Information 24 HR. ENERGENCY RISP01119 It: (209)983-16277 <br /> Q <br /> Z <br /> LU <br /> 2 <br /> t- <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by propershipping name and are classified,packed, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> J <br /> J If 1 am a large quantify generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> and the environment;OR,if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> available to me and that I can afford. <br /> 0 <br /> >. Printed/Typed Name .$igrtature � Mon!b-, Day �' ar <br /> U <br /> i (� 'r <br /> O T 17. Trans orter 1 Acknow ed ement of Rec t of Materials % ✓ <br /> R <br /> w A P' Typed a Signatur Man tfly Da ar <br /> LU S 6104\R ' " <br /> O0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> R Printed/Typed Name Signature <br /> Month Day Year <br /> N R <br /> E <br /> Q <br /> V IF 19. Discrepancy Indication Space <br /> C <br /> f <br /> L <br /> I 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Ty ed Name Signature Month Day Year <br /> Y _ <br /> C 7 l' <br /> fcefertmae Rwpler: E M2803 DO NOT WRITE BELbGV-FM75 iNE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A (1/99) (Generatdrs 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 />