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State of lifornia Environmerlfal Protection Agency �U �l�—t � � <br /> /IR"fTiPmxiTpad OMB No. 50 0039 Expires 9.30 991 See Instrtions on back o` -e� Department of Toxic Substances Control <br /> R asen or type. Form designed�or use on elite 112•pilch ler. <br /> Sacramento,California <br /> '. <br /> 71A. <br /> UNIFORM HAZARDOUS 1• Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST b I 8 U 0 `J U 4 11is not required by Federal law. <br /> Zof <br /> ggelgtor's�I pj Mailingaddress A. State Manifest Document Number1 AdG [lei 96812030 <br /> r1..yy��AILB 1lgPOkT )SLIDLOWOk, CA 95212 B. Stare Generator's ID <br /> eneraror's Phone ( AN �W-6278 Contact: PAT EUAk K <br /> ,5. Trpnsporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID <br /> 0 �) fCA <br /> o MEC EKVIROR!MAL TECH. A V 0 0 7 4 5 2 6 5 7 <br /> o f I I I 1 11 1 j I I I I D. Transporter's Phone <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID <br /> J <br /> - J <br /> C 8 O O -7 7 F. Transporter's Phone CS <br /> rr. < 9. Designated Facility Name and Site Address 10. US EPA ID Number G. Stat Fa 'Iity, IDD 0 9 0 1 3 3 8 9 <br /> RONIC EYVIROHAMIL TECH - SW 1! <br /> 6760 V LUISON ROAD A Z D U 0 9 0 1 5 3 8 9 H. Facility's Phone <br /> MMLER, AZ 83224 <br /> 1. US DOT Description(includingProper Shipping Name,Hazard Class,and ID Number 12. Containers 13. Total 14. Unit <br /> wf�lJ p P FP g ) No. Type Quantity Wt/Vol I, Waste Number <br /> WL K.O.S. Stale <br /> a �•p • • Zb <br /> IC4A LIGHT BALLASTSI <br /> 3 c D F � EPA/Other MOVE � <br /> E Prf l;r C 30.1160 ERG,t 171 , <br /> oN b. <br /> 000 0E State <br /> N R EPA/Other <br /> V A j <br /> `. 1 <br /> o T State <br /> ao O <br /> R EPA/Other <br /> LU d State <br /> Z I <br /> W <br /> V <br /> EPA/Other t <br /> LU <br /> h J..Additional Descriptions for Materials listed Above <br /> Z K. Handling Codes for Wastes Listed Above <br /> 0 <br /> d b. <br /> LU <br /> o <br /> oc <br /> J <br /> C. d. 1 <br /> Q 1 <br /> Z 15. Special Handling Instructions and Additional Information -4 It EMERGE RESPONSE Is (209)983-6278 <br /> l— <br /> Q <br /> Z <br /> LU <br /> r— <br /> �-+ 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> Vg marked,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,1 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 /> a 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 /> ti 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 /> 0 <br /> available to me and that I can afford. <br /> VPrint /Typed Name Signature, _ Month Day Year <br /> Z. Yet T f� S O !✓ O :V 3 7 9 T 17. Transporter 1 Acknowledgement of Receipt 61 Materials <br /> W R <br /> LU A Printed/T a Signatur <br /> N <br /> P Month Day Year <br /> W r d Q 7 <br /> LL0 18. ra sorter 2 knowled ement of R ei t aterials <br /> 0 Rp(t.dA <br /> LU N T ed e / Signature M th Da Year <br /> V) /1 r. I 15111 <br /> Q (( -L- / Y <br /> V 1 iscrepancyIndication Space <br /> Z F <br /> A <br /> C <br /> I - <br /> L <br /> %in <br /> Foci i Owner or O erator ertificat n of recei t of hazardous materials covered b this manifest a Item 19. <br /> T / ped Nome Sign Month Day Year <br /> lRifdreace Bu er: C 004000144 1 91 <br /> DO NOT WR TE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A (4197) (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 />