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f 'State of California—Environmental Protection Agency
<br />r _ Fb,-Farnr414%proved OMS No. 2050-0039 (Expires 9-30-94} See IrlS}rUCtICns on 6at.k oge 6.
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<br />UNIFpRM HAZARDOUS
<br />1. G'enerator's US EPA ID No. Manifest Document No,
<br />2. Page 1 Information in the shaded areas
<br />WASTE MANIFEST'
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<br />/State
<br />, of � is not required by Federal law.
<br />' 3. Generator's Name and Mailing Address - -
<br />A Manifest Document Num -1' ..
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<br />913.$
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<br />iY73 Via.. 4r, 'Sfo.e eE��'S�6
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<br />4.. Generator`s Phone' © -
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<br />5. Transporter 1 Company. ams i - _ " " '. b. US EPA' ID Number
<br />C State Tronsporieea
<br />A - - 1511493161 I *y
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<br />D Trao perter'3 Phone
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<br />7:' Transparter 2 Company N e B_.' USEPA ID qu.ber
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<br />9. DesignatedFacilityName and Site Address 10. US EPA ID Number
<br />G., State Facilii- s ID ,
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<br />H. Fpciliiy's Phone
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<br />11. US DOT Descri tion includin Pro r Shi n Name, Hazard Class, and ID Number
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<br />12. Containers
<br />13. Total
<br />Quantity
<br />14. Unit
<br />Wt Vol
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<br />1. Waste N+tnaber v
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<br />J Ad fai�aalaf Dr<t,ti ions for MaBerials Listed Above _
<br />K, `r ondlinq Codes for Vf 43e5 E stt,d:A{7gve h xtF
<br />}�. 11154
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<br />15. Speciof Handling Instructions and Additional Informari— � -
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<br />Trn AS Pei -Ter* 3' "If ffro i I CPlnp, Ep# 4: D PAOd 30.1 d orl0 1b'W0 'C 36/7f 41,t. -e.- c l
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<br />l E RATOR'S CE I QN: ere y ,dare at he contents of this cons nment o fulfyiand aceurately described above by proper shipping name and are classified
<br />pocked mor -ed, and labeled, dnd oie in all res in proper condition for transport by highway oecording to appli€able iniernotional and notional government regulations.
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<br />Ifs arras large quantity genefatpr, l ceYi{y-that-J cove a program.in.place to reducg thg volume and toxicity of. waste generated to -the degree,.l.have.determmed_.to be
<br />':economically'practicable and Thal I have'selected the proaticable metNod'df ireatmem,'storage, or cispoicil-currently'available tome which minimizes the 'present and future
<br />threat to human health'ond the environment; -OR, if. I am asmall quontity generator, I.hove made a good faith effort to minimize my waste generation and select the best
<br />'me
<br />waste mono einent method that is available to and that I can afford.
<br />Printed/Typed Name s J . . __.,- __,,.." ...,
<br />Signature
<br />Month Day. Year `
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<br />17. Trans rter'1 Acknowled emeit} f Receipt of Materials
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<br />18.- Trans Drier 2 Acknowledgement of Receipt of Materials -
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<br />20. Focilify Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in'ttem 1'9:
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<br />Printed/Typed Name 0AJ ./^yc f1Ac pj=
<br />Signature_._ f
<br />Month'. Day Year
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<br />DTSC;8022A (9/93)
<br />EPA 8700=22
<br />DO NOT WRITE BELOW THIS LINE.
<br />Yeffowr TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS,
<br />(Generators who submit hazardous waste for transport out-of-state,
<br />produce completed copy of this copy and send to DTSC within 30 days.)
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