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State of Califarnio—Environmemal Protection Agency <br /> Form Approved OMB No.2050-0039 jExpires 9-30-99t See instructions on back of a 6. Department of Toxic Sutssae.Co.".: <br /> Pleas,e prim w type. Frnm designed(w .,eon dire(12 ibr. Sacramento,Colifomf¢ <br /> UNIFORM HAZARDOUS mw s U5 EPA 1D Na. Mow{ea o«amm•. 2- Fogel is not r hm ed by Feuded areas <br /> � f J� , f y,,,... -' t�� � is rrof required by Federal law. <br /> i <br /> WASTE MANIFEST /�. ;' y of <br /> 3. Genembr s Name and Mailing Address r y I {"' r A. State Manifest Documenl Number <br /> Ak�� Ff� 23436588 <br /> b. Shste GenerMw's ID <br /> h ✓tr j <br /> h d. Gevam<:,r's Phcne <br /> n <br /> 6. US EPA ID Nun ber C State Transpor e,ID JR..ed.I i. <br /> ti .L D. Transpwbr's Phone 610/7%-4400 <br /> O <br /> m 7. Inur,c;,er Z Camconv Neme ai 8. US EPA to Number E State hanspoAer's ID[Res.=ad.j <br /> *)61wia 044!1 <br /> Q '. .• O ''{` •� g 7 11 9 is P Trangowfar's Phone <br /> :.i U <br /> P. Dssignaiea r Name and Site Address 10. US EPA ID Number G. Some Faciliys ID <br /> " Q 1 ' <br /> V to II {� .. ti 3 a 8H, foeiliys Pb. <br /> Q12. Containers 13. Total 14. Unit <br /> U <br /> 11, US DOT Desmp�ioe floduaing Proper Shipping Nome,H¢:nrd Class,and 10 Number] Na' Type Ouanlity Wt/Yol 1, Waste Number <br /> smote ; <br /> 3 G ..,":arGe.�� L P PS EPA2 '7.2C: I <br /> o N b' "sbte <br /> m E <br /> -. R .EPA/Other <br /> vA C Slate <br /> o T <br /> a' R EPA/Cehw <br /> WW d State <br /> t— <br /> Z <br /> W <br /> U EPA/Other <br /> W <br /> ZJ. Addinond Dasgip{({p�ss/f�ojr Mvrerials listed Above K HanoYing Codresfar Wassel lissad Above <br /> y as <br /> ce <br /> 0 15. Special Handing Instructions and Addiswrrvl lnfurmalion <br /> A.7L11tJaUi:Phil' P iWi_AXic RAM I 1b.. 1 <br /> v 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this coniroarnentawfully and aecurat�(y described.6.6y proper shipping come and ore dass4fied,packed, <br /> Vmarked,and labeled,and wa in all razpech in proper condition for transport by highway acmrdug b applicable interrwtional and nafianvl government regulations <br /> If 1 ora a forge q.art,generator,t certify that I have a proM in plots to raduca the volume and toxicity of waste generated b the degree 16.determined b be a<onomimiy i <br /> b practicable and that i have selected the pracMobta method of treatment,storage,or disposal currently ovwtable to me which minimizes the present and future threat to human heal <br /> and the environment;OR,if 1 am a sma I quanfily generabq 1 have made a good faith effort to minimize my wash g...fi.n and select the best wash management method that a <br /> wailabis b me and that 1 can afford. <br /> O 1 <br /> y ) o ed/Typed Nome _ Signal'. Month Day, Year <br /> T 17, Tmns'orter 7 A .ledgement of Re i t of Materials <br /> W A Primed/Typed hnt� rd ./ Sgn¢t / /�sf Month y Year <br /> LL KS <br /> 0 18. Tr "nu 2 Ackaowlad amen aFReca ofltmvids f 1 <br /> O 7e PrinaclKyped Name SignaNre Month Day Year <br /> sO F <br /> R <br /> U19. Discrepancy Indication Space it <br /> A <br /> C <br /> f <br /> L <br /> 1 20, Eacil7 Owner ar O r¢roc CerliRmtion of ren? t of hazardous materials covered b this manifest este t as noted in Nem 79. <br /> T Prhaed/Typed N¢me Sgnawre Month Day Year <br /> Y <br /> tf �� DO NOT WRITE BROW THIS UNE. <br /> DTSC 8022A f1/991 Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />