|
' �` De artinem of Toxic Substances Control Y'
<br /> State of California—Environmental Protection Agenry Sge Instruellans T]n baek,t�f pl, b•'. P - 'Sacramento,Coliforms
<br /> Farm Approved OMB No.2050-0039(Expires 9.30 991 A 3
<br /> Please print or-type.' Form designed far use on'elire f 12 itch) riror r
<br /> l.'c4enerahor's US EPA,iD Nor= Manifest-Document N .-;K 2 Page 1''. Inlormatiari in the shaded areas
<br /> is.noh-requlred-by Federal law
<br /> HAZARDOUS
<br /> - UNIFORM HAZAR ,�' ._� �",^�• 3 � of � � ,�
<br /> MANIFEST',
<br /> 'WASTE _MAN _
<br /> W
<br /> -
<br /> � Oocv e -
<br /> `A.s.$cute Manifesk m �,
<br /> �Tir� M•�..TMfY��j ��!`w✓ �•N �� 4'.�x.Y' E�--k ,.�. �' L !�',8 6 6Y}
<br /> 3. Generator's NamAe and M+a�irliy�nyg Addressesi{y` i r !�'y .�M -, , trNN
<br /> AI
<br /> 5V0 VIil1 Q�k.Vd1'�l.rlurG-' G4V! y„_ 9 tote Geri®rarar3lD $ ' '„ y v' _ r -�
<br /> • ,
<br /> rn ” '� w�f
<br /> 4. Generators.Pfione( 1
<br /> 6 US EPA ID Number C 'SFateTransporTeYs({ Reserved)' +
<br /> i. Transporter l Compdny,'Name iv '
<br /> �,-, bxTrarrsparTer'�sPf+aiee�;.-:'�.{ ���s
<br /> W s�'1 e�lYdi� '�3 �{Mtvl�Ilg r w
<br /> ii 8 S A D um er El Skate- spo? "y ese ]..v-" 4pgk$iva 1
<br /> -7.'Transporter 2 Company r t �a _!f
<br /> '
<br /> 1 ' r FTransporrers Plrone rs � � ,.5 -fs t
<br /> iQ. f6 G store F uh
<br /> V 9 , F ii1 S 3e'�3nd iY'Ab f s�': IVI )1 1�t �+' 10 US EPA lD Number r � r _-' F r L ......
<br /> Cd ��+� { - C x i .V - iY "Ai
<br /> (
<br /> �F!, i
<br /> LL - - 12 Contomers 13 Total 14.- Unit -
<br /> Qvanh Wt/Vo1 f Waste Number L
<br /> `UI` 11.'US DOT Description(including Proper Shipping Name,Hazard Class and-ID Numberl a r:':-., Na T e -77
<br /> ty SS
<br /> �.� 77�: Hazardouv'.� 3�te�.,1£111.t�. �LJ'�S�i�i .,`e ; 7a• . .r..-' ti `: '� {
<br /> EPA/Ohher�.# _ r
<br /> G State s a
<br /> E 6.
<br /> N
<br /> 's EPA/Other 00
<br /> ".....
<br /> co
<br /> CN
<br /> r< J i
<br /> I as .O. 4g}k^
<br /> 17
<br /> Lu d �
<br /> o. EPAlOfher- s - s
<br /> LU
<br /> LU w rs F� rn �s'e + rt ] tiandlmg Cod for Wastes Lssied Aboverk -� ke `i
<br /> E `.W .? i isrial=D cr'i tions far t.'late�ials.Ltsred'Y�6ove 010. r �}-:�g. .qq.u�'r -s'%� + ,".' t„r'h,?;+,+- - ,',""Y..'� �-v`'{"Y` 7+,p-"'` '�''` ��� # �
<br /> I ^). 'Add' all i.:+'',9 .'kY+,n.. _•-t3 �i' �f- .�aw;.Fs.fi' -'w'+.-fy �.s',.S}�- ,.�k�- e'_r 'fir* a13�<. Y - Eits,t-r;�{ F1.�,T'�w �, '4,wx.F,-s -w,?�:,,,Na^ k.,
<br /> F ,}r f ,, .-..��t""i x° .2&rn. 5 '• Y��s ,': [is
<br /> I 1-,YP••',. R °r,� .�§;'`��".t••b,f}� � ✓ '� " a� *%y - :' ^uwS;x� -«e,.'��rr.�v-E'`..;+W'y'?-..-r.`"'r' -` yJ.-
<br /> .r��,y'�^:s r.�i
<br /> .. �:.k• "t4F1 SIT,+C, 13-
<br /> r*-,4�rf i ''i f ,. -'t ,`.; n 6�.,. eu •,.v^T�v°' F,� �., ^�Y�� 4a .alt .,. t rt;C: is, " b i$ r h ey`' d:J' .LE' `-� y,'. ,:r,.gr'„ <,�
<br /> V.1; ' ref :'.5', k"N " .mr v 3y,y -v F�'C fin _it e .r• ; ,
<br /> d 7 d "`,.•k iS:;�y,' 'Nb`i'°'' ,Lp;''. '-,'. � -
<br /> 57-,fs .Nh :4;Ew dk..rf t„
<br /> w, rtrr- zwt'; �, _ r fid. - wryf rx y i
<br /> <<��"'; yr��s• r3:*T` - _rr7,!"-n � � L -
<br /> _a _ �' i T� : '�s �,t ✓ 7'rv'- »,., ta„r, 93 'd`;4 .> hx
<br /> Z, '15.•Special H .• rL��{,�n �tr ° `�LS � - r - _
<br /> `Sari 3atfi�Ta Fitter :~ccltz�g
<br /> E a V 1�lFttE�p [ S-�c-r l;zC �S _
<br /> 7.
<br /> ..
<br /> are Thal the contend of this rnnsi nreienh ate fully and atftirarel described above by proper shipping name and aw classlfted'packed
<br /> GENERATOR'S CERTIFICATION: (heresy decl !e international and nalional government regulations. ;j t
<br /> l J 16
<br /> R Q marked,and labeled and are in all respects in proper condition for Yranaport by highway according ro npp tcab y x
<br /> •r - yy
<br /> e ucnil enerdkor,('cattily that l,have-a pro,ram in place to reduce the volume and toxicity of-waste generated kirazze7 dhgTeesen and futume Ihreat to human health
<br /> IF Lam4a la ge q tY g g
<br /> a practicable and that I haus ielecled The raclicable method a{.treatment,storage,or disposal.curremly a4ailablNe si m enertahon and select the best waste management method that is
<br /> and rhe environment;OR,''if,fam a small gaanlity generotor,J have made a good faith effort do mlmrmxe my g
<br /> ovaila6le to me,and that I can afford
<br /> .Q . - Mont -Day Year -
<br /> .Primed/T 'e ame w q _ r Signature y -
<br /> Z Y J ►;yet
<br /> LU i 17 Transporter 1 Ackbowled emenl of Recei t of oterials d
<br /> R Si' rut 'Monlh' Day Year
<br /> X PrimedldNome �' '•
<br /> S
<br /> LLI
<br /> �u -
<br /> t w ,p lb. Trans� rter 2 Atknowlad ement of Recei t of Materials .' Month Day Year
<br /> -T Printed/Typed Names�. Signature,
<br /> -- t yA
<br /> ' V R 19.Discrepancy Ind'
<br /> lcahan Pace
<br /> -
<br /> r k
<br /> — A �� � res ',L '' �`' ' z �' �,_ , _,� •t L _5' - F - <
<br /> x.
<br /> �. w
<br /> Facility Ownaror O erator Certification of recei i of hazardous materials covered b-flus mani ex t as not n Irom 19 Month Day
<br /> Year„
<br /> Printed/TyRed Name' -
<br /> T �++r, s '�` {'� yam,,,) �' �" t�``• � 4.+r � O+ � �
<br /> Y �t
<br /> ;s 11 DO NOT W�RkTE BELOW THiS LINE
<br /> Yellow TSDF SENbS THIS CaPY TO GENERATOR WITtfIN 30 DAYS
<br /> K (Generators who submlk'hazardous waste for transpoet.out-of-state,
<br /> DTSC 8022A(l/99] Produce.completed copy'of this copy an
<br /> d'send to DTSC within 30 da'ys.f
<br /> EPA 8700-22 s + `
<br />
|