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to of CaMfo a- nvJFonnf Antal Protection Agency ]f sgg Ii1S�� Ct10115.GRC�C OF Dag, Department of Toxic Substances Control' <br /> raved OMB lsio-20$q-0039[Expires 9-30-99), <br /> $ocromento,California" - <br /> .m App r <br /> ase pont or type_. Farm',dasigned for use an elite(12 p+tch]: +ter. <br /> 1 Generator s SIS EPA 3D Na Manifask eument No - 2. _Page ! :Information m the shaded areas - <br /> UNIFORM HAZARDOUSrj snot requ+red 6y Federal low <br /> WASTE MANIFEST ; 33 ''� y2 1 J' 1 of <br /> „ Ar,Stole MamFasY Dotumegm,pt Number a tir <br /> Name and Mailing Address 3 krra `85�y` <br /> 3. Generator's N g PaGUill� �. a',Y3` rv'.�5,iz �' �' " V <br /> 1.117t�ced West rn:GiL�C'i8 S a drq,� r r 3m a9r yxi r <br /> ' x a 5 T <br /> /r Sheila JFBsa� Stote'Genera s ID d r � 1i # v <br /> �y r (` r'.,�te44',••ri:4f 11 4'� k�, a �+ :n .�y�} +. <br /> + d <br /> C3''PRnsne�� `y'�i ?d tom. � t-t` r � -�r'�t� <br /> s <br /> 6' US EPA 1D Number+ t Sta#e Tdons iter s ID[Reserved] "c <br /> . mp <br /> 5. Transporter l-Company Name <br /> - <br /> _ tTrons <br /> ] s 7. Tions oiler <br /> S. US EPA ID Number' E j$tale Tparte (R -} fya"� <br /> _ tori s ID s�� <br /> O p 2 Company Nameadi�,,lar s a�n° 3e .,r.'" '� <br /> F-7TrcnsparMrsrPhoneFi4M��4ah + Y# nL- <br /> J <br /> Q 10: US EPA.1D Number:- G `Shite Fosjlril/a Is g s b - <br /> aaU Name and Site Address <br /> J 9 DesignoSed F tY - §{ y +} F+ .-Fa _? s r �y 1ir ��kffW <br /> aSC 5 <br /> QCr <br /> ���Bt.(Ne WF1 H Fncrlrrky s Fiona _ °env qac* € r � <br /> S$i iryhl�'- k^ .r Z'3h <br /> 1 Yt,"�.1 ti! Ff+-�r�� f ,xisr-�m��VG� yyLw, aW+i7 ra .e s�' <br /> `� ; .12. Containers ,13 Tata] 1A-.Unit <br /> 1 - �'r Ouanlity .Wt/--Vol Yv1Nasle I+Fureber y�,'w -' s' <br /> t15 DOT peycr scrip (including Proper Shipping Nome Hazard Class,and ID Number] Ssale # mob <br /> :Z a. '_ <br /> WASTE Aert SOS F''�3ki1 Y13;J�� � � sEPA/Othg� <br /> `2.1,UN49�3. a <br /> C7 i <br /> n <br /> o-7 i a <br /> t <br /> Voiwil 57 <br /> co <br /> tW— d t EPA'/btlr 3r e # <br /> Z LW <br /> . '~ 1 xx p d('HRJTEREN <br /> gndlsng'Codes for _asteS Lysted�bdYe° r F ' <br /> W Additioncl Descnphanstifo M�r _ V-1fi11VfRON�' EFA1rOFTO}CICSU�iRFSOURt� ALbR �'°` WkCCORiS GSTAN RIfY, vg.r �wkir �d a* <br /> s r+a�.Tf1E" 4fECf117NACIIYCY � y ro fir; d` <br /> W m l ;yr CDNSFRVATT0111 A ANCLt { s,�. d at• g r xx s� <br /> aid s c RjQ � _ ICFPfrIE 7105 RSfiY 3`UVF3tTY?NFAS'p - - N MPlIAb> � - r,.x � �C <br /> L s 4 4�_i. . La GI.YTv ai 5 YLR$N W "ARY / r�/ y <br /> y y� 1. 'r y- " AST1r HAS SET N HAND : <br /> i 5 Special Harty ing Instructions and Additional Information 0.r z. LED <br /> Glcafas +� GO les 5215 : //S <br /> J�Iwr Sl�a a9�i3 �Piccca�z Rd. <br /> h `� Si octan, GA 9 <br /> x a <br /> 9U9=8139-560? , <br /> s* " <br /> t N: I hereby declare that the contenf4 of this consignment ore fully and accuratelyy dell r'infarnationalyand naHoner s ial goyarnmerit egukationyfied packed `: - f� <br /> Q 16. GEF1EkATOR'S CERTIFICAT O Y g licab e <br /> marked„and labeled,and are in all respects in proper condition for hansport byhighway, accordyngio app <br /> ^ volume and toxicity of waste generated to the degree I have determined to be bconomicalk <br /> 'If 1 am a.Iarge quantiyi gene'ratbr,'I certify that I have-a`proggram in'-place to redsice theavoilobli to me, yh_ <br /> 0. {Sradicabla and that I have'selected the ppracticable'method of trsalmeni,stora9od faith efMFt to-cuoiolrmmim ze my waste generiati n�and'seled�the be ttwusdte man_agemaM1�mnlhod tF atlas_ - <br /> a and the environment;OR, <br /> if I am a smakl quantity generator,I have madea-go <br /> available to me and'that f can afford r '' £ <br /> _ a ', •. Month Day - Year <br /> .. s Z. <br /> Sig tuSe j i - - . <br /> Name ,-_•- r .- -�11y[, •''4 - �a - <br /> Z 1 r \ <br /> 7 Fti.J r <br /> W t 17..Transporter 1 Acknowled ement of Recei t of Materials ” <br /> Da <br /> arth-a 5 y Year' r <br /> Pri /T ed N me SignatureUj <br /> a <br /> u 0. 18 Transporter 2 Acknowled emenk of Recei I of Materials01 <br /> Months: Day' Year t <br /> -T,_ Printed/Tye ari+e <br /> Qr <br /> -V 19. Discrepancy Indication Space 1 ` - <br /> Z .A r r <br /> C <br /> .L c 3" + <br /> ] is m iFest exce t a 20. FacilityOwner or OP erator Certific n of rete f hazardous materials covered b noted yn Item 19 ant Year <br /> Signore <br /> - _T Printed/Typed Name g <br /> Y <br /> DO NOT WRITE ELO T 15'LIME A r } <br /> Yello,'. TSDF SENDS THIS.'COPY TO.GENERATOR WITHIN 3D DAYS <br /> c (Generbtots,who wbmit hazardous waste For transport our of state <br /> "DTSC 8022A []/99], y n produce,completed copy'oF this copy and sand to DISC wrthin'3Q days <br /> EPA 8700-22 ` <br />