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Stole al Califomio—Environmental Protection Agmry <br /> Form Approoed9MBNo.2050-0039(Expires 9.30.99) See Instructions On back 9e1�0395 Department of Toxic Substances Con <br /> III TO print or type. farm designed for use on elite 117-pitch rifer. 00103 Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID,No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST <br /> 0 7 7 3 4 $ 4 1 of 2 is not required by Federal low. <br /> 3. Gentl4k N...r.d.AnoO ndlgd 76 MW EEPOT C/O 313 te.Manifest Documenl Number <br /> 701 D'AWT PPiflJ��b AY 1905 ASTON AVEiUE *1 2448955 ' <br /> W) L8'1HRDP CA 95330 CARISM CA 92008 B. State Genera o/s ID <br /> 4. Generator's Phone <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. SlaleTran sporte/s ID[Reserved.] <br /> opo' 21st CERRM ENI CAR 0'O'0'0 5 2 8 0 3 D. Transporters Phone — <br /> 0 <br /> Loop 7. Transporter 2 Company Name US EPA ID Number E. State Tronsportefs ID[Reserved.I <br /> �� by <br /> LO'< I / It i0/9 O 3 ( 17167.Transporter's Phone <br /> (MU KditpS EPA ID Number 'G. Slot.Facility,.ID - <br /> 00z 20245 777H AVRM SOUTH 1RCdJ <br /> CTo< �'H'. Facility's Phone <br /> �o M Nf, WA 98032 K A D 9 9 1 8 IL71617: (253) 872-8030 <br /> J <br /> OQQ 12. Containers 13. Tocol IA. Unit <br /> U 11. US DOT Description finduding Proper Shipping Name,Hazard Class,and ID Number) 12. T 13. Tota I A. Vol I. Waste Number <br /> Z S a BASTE AMSOLS, PLABBABLB, B.O.S. (BBTB7L BTBTL am, BANIBN) Slate 352 <br /> 2.1 01951 I1G(126) p. K p <br /> 3 G EPA/Other DOM <br /> N E <br /> o Nt , , <br /> �W E !! <br /> .Q R D EPA/Otber <br /> 71' <br /> A <br /> no T 3I r r r Stale <br /> Jm 0 <br /> R <br /> �Z IC d' BASTE MHOSIPS LIQWIB, BASIC, IBOIGUIC, B.O.S. (SODIDB State 122 <br /> BTDBOIIDB, POTISSI0111MOHMI 1 013266 PGI IIG(154) D ? P EPA/Other <br /> 'At 'i) .931POII�rdHT'�Ille�lf9"= ABBOSOLS IBC12 [1J 6) 6.1L-11 DIIe K. Handling Codes for Wastes Listed Above <br /> 0111 D116 232 - TOWIC (LIQWIOS'OBLT) LOOSEPACI - =4 (2) c) BDIBPNST-II M8 a O b' <br /> 01110116 P111 P/12 P111 0243 - 191TILI11115 WITH PISTICIDIS LODSBPACI INC14 <br /> a (3) d) BOMB-$# ISC2 - ALIALIU/COMMS LOOSBPACI - 11134 (4) a. Q�;7 <br /> 15. Special Handling Inaructions and Add'rnonol Iclora,ceon <br /> a0 PIOPOSALI: 39677 24 B00B EMG61CT CONTACT: (811) 451-1346 <br /> LIUZ a)V01A2-30, �) uu1Aa- ) S <br /> J 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignmenlare fully and occuratelY described above by propershipying nameondaredassified,packed, <br /> Vmarked,and labeled,and cretin all respects in proper condition for transport by highway according to opplicable intensafional and national government regulations. <br /> J If I am Is large quantity generator,I certify that I have a program in place Io reduce the volume and toxicity of waste generated to the degree I have determined to be economicaIy <br /> Cs- practicable and that I have selected the practicable method o treatment,storage,or disposal currently available ro me which minimizes the present and future threat to human heolZ <br /> h <br /> and the environment; if I am o small quantity generator,I have made o good faith effort to minimize my waste generation and select the best waste management method that is <br /> O available to me and that at I can afford. <br /> VPrinted/Typed Nama ` w, r� Signe re Month Doy Year <br /> W T 17. Transporter 1 Acknawled ement of Receipt of Materials <br /> A Printed/Typed Name Signor M nth Day Year <br /> R Gat or.( S O <br /> w 5 _ <br /> 0 18. Trans after 2 Ackno led e to Recei t of Materials <br /> O R <br /> Print Sig re nth Day Year <br /> Q R 1 <br /> U 19. DiurepanrylndicaKan Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> 20. FocilityOuneror Operator Certification of mcei t of hazardous materials covered 6 Ihis manifest exce t os noted in Item 19. <br /> T Ainted/Typed Nome Signature J Month Day Year <br /> Y � Comb o ' <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A I1/991 __ _ — —_ __ White: TSDF SENDS THIS COPY TO DTSC WrrHIN 30 DAYS. <br /> EPA 8700-22 To: P.O. Box 3000, Sacramento, CA 95812 <br /> - — r JUN 6 AH 3:42 <br />