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-f State of California—Environmental Protection Agency Form Approved OMB No.2050-0039(Expires 9-30-99) See Instructions On back OE Page 6. Department of Toxic Substances Control Please print or type. Form designed for use on elite(12-pitch) iter. Sacramento,California UNIFORM HAZARDOUS 1. enerator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas WASTE MANIFEST / I r ;"� t� � � yC—I Cy of is not required by Federal law. 3. Generator's Name and Mailing Address /' / 1 ✓ C + J A. State Manifest Document Number � 23489060 O) — /+y��y� � f r 1r + B. State Generator's ID in A. Generator's Phone + 7- CN 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] OP st',taa �O ,i'1�I I ,i c- A D 9 8 2 4. It .3 1 P 6 a? D. Transporter's PhoneOF 7. lr. rt¢ J G Aleme:� 8. US EPA ID Number E. State Transporter's ID Reserved. r �r�'� to �tt� Cl.fi3t`� t P [Reserved.] Q Rw6a)IA rim, IN(,`- C A 1) {� lei ,? 5 4 tr 9 C/ l3 F. Transporter's Phone U 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID .5 )K Iry is mma .v 2095 -AN WIVII IMAST O :Its E0408 N � D 9 a U 5 11) 5 i .'.S SH. Facility's Phone 11115V--xi75---::'1tWj ! J Q 11. D Description(including Proper Sf ipping Name,Hazsprd Class,and ID Number) 12. Containers 13. Total 14. Unit U P P No. Type Quantity Wt/Vol I. Waste Number 2 ` / _X 7 ��I �t'• �i J i3'I rI �J ' A 1 State 3 G 1 t ^ f1 r { EPA/�ther r o 61 Nir<� �CN. /P /`7i✓`'! , � L! , r�1�*� �}/_�/ �� a00o E �1 L % �� 711 .� r� EPA/Ot r C14 A171 Ow O S� {F�'r�,/� /Z �lcf�Z / /�,�(� �� G. �. Smte aoo EP / th �I� f �f✓�` ?l 7`�: �r^y7 1 1 ✓I FW— d - State Z LU U EPA/Other LU Z J. Additional Descri Eons for Materials Listed Above J K. Handling Codes for Wastes Listed Above K o f�.rl bCL -_ - -�- Uj 11) J-7-0H Q 15. Special Hanell g�pstructions and Additional information FS� - . Q ,,ts Milk �t r�,l��,,,ss-y�r��77-�.{f�L;rn-rrrtI�n,;ps�sq��ry'�- T��t�.d 7-y f �n r! f Z 24 I'lt ilk ncstlRGfXgG' C.l�iTi.t P.1�.rL,C:fyy.��.f..nr��.17}-. fN11"i..fyrrF.sa'.K i�MJAM1,%) LU 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, Vmarked,and labeled,and are in all respects in proper condition for transport by hig6ay according to applicable international and national government regulations. If I am a large quantity generator,I 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 V) practicable and that I have selected the practicable method of treatment,storage,o-disposal currently available to me which minimizes the present and future threat to human health 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 be O available to me and that I can afford. > Prin_te_d/Typed Name Signature_: Month Day Year. Z }y i t "7 IL T 17. Transporter 1 Ackj"44fdgement of Receipt of Materials w p Printed/Typed Names J + Signature - `' 1v�onth+ Day/ ;ear S f // G' f Q0 18. Trans rter 2 Acknowle" ement oflecei t o Materials ' T Printed�!•lyped Name Signotur7 Month Day Year w E Q R U 19. Discrepancy Indication Space Z F - A C I L 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. T Printed/Typed Name Signature Month Day Year Y 1 7 1 1 1 1 1 / DO NOT WRITE BELOW THIS LINE. DTSC 80 (1/99) EPA 8700-0-22 Yellow: GENERATOR RETAINS