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mateor 1588 InSirUCtlOn5 On DOCKOT POSO O. B ve a sma •.•..-•..•• ... m <br /> Form Approved(O_M�B No.2050-0039(Expires 9.30-99) Sacraments,California <br /> Please print or type. Form designed forum on*fire(12-pitch)typewriter. <br /> 1. rotor's US EPA ID No. Manifest Dacumeal Nr 2. Pae I Information in bre shaded areas <br /> UNIFORM HAZARDOUS G is not required by Federal law. <br /> WASTE MANIFEST Olo Z 13112V p 3 O Z af� <br /> 3. Generator's Name and Moiling Address/rr/ft C/)/71C SJ'b7lr�s A. Sate Manifest Document Number <br /> z9� R�a�ae 4r1. 24818305 <br /> e4 4��� B. Sale Generator,ID -- <br /> O ,,pr <br /> rr, .. Generator',Phone(2�'/ <br /> )3!Yl,—oz� _ L. <br /> sV 5. Transporter 1 Company Name 6. US EPA ID NumMr <br /> C. Stale Tramport•rs ID Rm.r".d.1 - <br /> 471 <br /> gnlvw5 l twi;?[o✓M r,✓;41 A Q <br /> sas o N N o S D. Trompa le",Pha 4/./);}I_S <br /> o? 7. Transporter 2 Company Name 8. US EPA ID Number E. Slate Transporters ID 1111-1"20.1 <br /> j F-Tromporteh Phone <br /> G. Stara Facilil�slD <br /> 9. Dnignarod Facility Nome and Site Address 10. US EPA ID Number <br />�Q c �, <br /> 10z q$Ss V-4110 &ty k/1 H. Fac81y, <br />>Oo /1�' 61/^G S 6 <br /> R9N/Ho !O�/v✓A fA 957YZ cA 9 Sf $ If 12. Co t <br /> 7Q 12. Containers 13. Total Ua. Un -• - <br /> V V 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Numberl No 7 Ouontity Wt/Vol I. Waste Number <br /> Z a. Wr?§/! Lfri/!I'Jr7i, yK✓10 teas/ � /�/� / Seta .7 <br /> OR490 6- <br /> Slate <br /> C N b. <br /> m E 'EPA/other <br /> e A Sate <br /> c. <br /> m T EPA/Other <br /> WR Sat. <br /> W d. <br /> Z '. _ .EPA/Other <br /> W '%+YN`v K IWndlrng Codes for Waste Listed Above <br /> J. AddiBonal Descriptions For Materials Listed Above qr'^'+. _ _+- <br /> ren) P4tiFiie ,Q67oG S7�SS �> . a = b. <br /> N .. <br /> d. <br /> Q '•ate y] <br /> 0 15. Special Handling Instructions and Additional Information H.9,u&1W$ f ��•/ �- //,o r1f9i1-/0 �NwI VS" !J/�Y//`�% <br /> 1< <br /> !_ - <br /> = r�ii1�i'/ Py�y✓� �`C9/�;3,��-s�y�- - ,sf�+t2.1'�e2S �-af r�sS�� <br /> r <br /> 16. GENERATOR'S CERTIFICATION: (hereby declare that the contents of transport <br /> according <br /> torateF/dacribedabov by proper d nations, <br /> nam•and an classified,packed, <br /> Q marked,and labeled,and are in all respects in proper condition For Transport y highway according a app/cable international and national govarnm•nt regulations. <br /> V <br /> J.+ II I am a large gvanti generator,I cervi that I have a ogram in lace to reduce dre vdvme and axicity of wast•generated to the degree I have determined a be economically <br /> e e y p { p or di rr•nlly available a ms which minimises dr•present and fatar2 threat a human health <br /> d practicable and thatl ave selected the racticable method o treatment,storage, <br /> and dre environm ml,OR,if I am a small quantity generator,I have mode a good I • a inimize my waste generation and select the best waste management method that is <br /> oe available to me and that I can afford. <br /> 0Printed/T Sign urE' Month Day Year <br /> z f �F17jC3 S�iH'� lj o - <br /> W T 17. Trans rter 1 Ackn ToFRecei toLM01mials <br /> ySi nae Mand/ Day Year <br /> W E Printed/Typed Nam / B a <br /> W P <br /> ul. 8 18. Tram rtar 2 Acknowle------I of Raceiot of Materials Mon* Day Yea <br /> 0 Printed/Typed Name Signature <br /> N E <br /> A <br /> V19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> 1 <br /> L <br /> 1 20. Facili Owner or 0---Certlficotion of r...icit of hazardous materials covered by this manitest"color as noted in Item 19. Mead/ Day Yea <br /> 7 Printed/Typed Nome Signaters <br /> s- <br /> Y « `� <br /> DO NOT WRITE BELOW THIS LINE. <br /> Blue: GENERATOR SENDS THIS COPY"O DTSC WITHIN 30 DAYS. <br /> DTSC 8022A (1/99) To: P.O. Box 000. Sacramento, CA 958120600 <br /> EPA 8700-22 <br />