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7-7,77
<br /> State of California ErM 6nmentol'41rotedion Agency {
<br /> Form Approved OMB No.2050-0039[Expires 9-30 991 '� `L;,, s t `See Instructlans an back'of r� Department.af Toxic SvbstanceSControl
<br /> Please print oc'type. Form designed For use i elite{12-pitchf'' Star
<br /> _ ! Sacrari onto,California
<br /> 1 Generator's US EPA ID:No., l Manifest Dncumenf No. 2..Page 1 Information in the shaded areas
<br /> " bNIFORM HAZAR US r is not required by Federal law
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<br /> W/4STE MANIFES �' { ? 9 ? ] '3 �3 ,.5J Q
<br /> e A,State Mani4est Rcment Number + t-
<br /> 3: Generator's Name and Mailing Ac>dress ,• A� Pat GURIO � u 24 7
<br /> UenifW,Westaym Gr�t�
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<br /> 52(10$�Itp11a.S reef `l B"State C+erl6rators !f °`Q.4-
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<br /> nC k$tate Trona rter a ID,
<br /> N 5, Transporter 1 Company Name s, - 6 US EPA-ID Number _ Pam[..�_. .tas•# s -
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<br /> O Q Tiansporfer s Phonex' '� h px"ICA_ 080-012807
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<br /> .� e 8 USEPA IDNumb
<br /> 7: Transporter 2 Coor
<br /> r E SloleTransparteralD[Reserved-]:�*� tt � '�'i'*^as .'
<br /> -, mpany Nama
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<br /> U i0 US EPA ID Number G State FocingJs ID . - f r 'ttr '
<br /> 9-,Designated Facility Nome and Site Address
<br /> SetrvlC s(C iifiomia)i Inc ��:� " _� �� � xr dv k
<br /> 4:5 U.S. Filter Rec'av'efy. H Focs[i :Phone ° � .
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<br /> O, 5375'South SoYJr �2327�-1U
<br /> _ .alm= CA 910M
<br /> 12. Containers p 13 Total - 14. Unit 1"',yr yi -' t`a
<br /> 11. US DOT Description[including Proper Shipping Name,Hazard Class,and ID Numberl No Tipe QuaNity• Wt Vol I 'VYost�Nvmlier?s�'
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<br /> Non Ha zarctous WVast9 Salir3
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<br /> Non-RCRA,Haxarrious Waste Uq uid '
<br /> E. r TEPA/011ie
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<br /> Stata �xx
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<br /> CEPA/Other
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<br /> Z EPA/{Other " *
<br /> u.i77,77-7ax pie=-- s,ti'r ry KHand[mg C6des for 1Vasles li;ted Also+re�s�syr `
<br /> 1:r Additional Descn tioiisforlhatenal"s ;. *, r - _
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<br /> Q li� pllldlt'1 {E�➢raGir E� ['�6"T,I WFIT."�`yya�f�'i �'i.�x,§'F+1" '�- .''[]-e/>I -y'- rfy,r {.
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<br /> an Ad tonallnformatian /
<br /> I5. Special Handhn Inst dio L X53 }
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<br /> �, Emg. X989 889-560] '
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<br /> 16. GENERATOR 5 CERTIFICATION: I hereby declare that the contents of this const iiment are fully'and accurate) described above by proper ship ing name and are'classified,packed }
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<br /> I V marked,and labeled,and are in all respects in proper condition for,transport by highway according to applicable international and national;governmenf regulahi0ns�
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<br /> If I am a Iprge gvantiy-generator;I certify that I have a program in place to seduce!ha volume and toxicity of waste generated to the degrae_I have determined to be economicallyi-
<br /> � practicable and shot I hove ielected the ppraclicable method of treatment,storage,or disposal currently available to me which minimizes the present and[afore ihieat to human health-
<br /> and the environment;OR,if I:am a small.quonlity generator;I have made a good,faith effort to minimize my waste generation and select the best waste managemenE method thus is'E,
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<br /> O available"ro me and that I ccn'afford
<br /> Printed/Typed N Month Day 1 Year
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<br /> R 17. Trans otter 1Acknowled ement of Recei t of Materials
<br /> 0Month.'- Da Year s
<br /> - Signature Y;- _
<br /> A Print d Typed ljpmeUj
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<br /> LU ' S /= Y
<br /> - p 18. Frons orter 2 Acknowled emeni of Receipt of Materials
<br /> R' Printed/Typed Si oture
<br /> Month` Day, Year
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<br /> V19. Discrepancy Indication Space,-.
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<br /> 20. Facility Owner o orator ification of recei of a us materials covered b this manifest exc s noted in Item 19
<br /> Printed/Typed Name - Sagnature �n -
<br /> Month
<br /> Day: Year- r
<br /> Y r Axl A
<br /> 7 DO NOT WRITE-.BELOW THI5iNE _
<br /> ;art.:
<br /> Yellow, TSf dSENDS THIS COPY''.TO GENERATOR:WITHIN`30.DAYS ,:
<br /> {Generators'viho submit hazardous waste for transport out oF-stoic, `
<br /> N DTSC 8022A[1/99] produce completed copy of this copy and.ser, ;to•DTSC within
<br /> -30 days.[
<br /> EPA 8700-22
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