|
;� See Instructions on bask of P DepaAmenf of TaxiaSvbstances Control
<br /> State of 5—Environmental Protection Agency ' Sacramento,California
<br /> Farm P II No.2050-0039(Expires 9,30 99) y y_
<br /> Please ...,or type. form designed for use on efite(12-pitchJ h Stet .'
<br /> _ 1. venerotar_s US EPA 1D Na. Hlanifest Document Na:-;,.'k' 2 Page 1..• '.lnformotion in,the-shaded areas '
<br /> i rs not r_equtrad by Federal law
<br /> UNIFORM HAZARDOUS aF i
<br /> WASTE MANIFEST : �1 {mss
<br /> AM�11 �i,+ �� ,.1x. A Siofta Mamfesr Document Nuber- ^ _
<br /> 3. . rL
<br /> 1{Ge�n`rerrcitto11 `Name andel Mailing Address [/� )� y `�N Mti+ 2� x; I k i i
<br /> V 1�f5 � -v7c" �.J�4i:.i �• r � •
<br /> 5ao� S fL'11�H`�.��7�T ��InM QXZ'C +�y 1 rr vn r °x' a � ga s4 • a: "tea
<br /> in .. �/�f - pV`w '` Y Fin 4:.Generator's'Phone F I ,
<br /> 6 135 EPA ID Number C Stale Traesporier s'IU I eserve ] � ' ��x , -
<br /> -c:r 5: Transporter 1-Company.Name
<br /> mi�11Qrs�fr11 ! �tE1 �I>IRI D 'TtarSsporter s Phone ": c� 4 a
<br /> d
<br /> Num r , -
<br /> 7 Transporter '�
<br /> a". ` F Iransporter'`s FF�one', i51
<br /> Q G�Sfate P ilify a ID". �'
<br /> 9. D€eYc�F4e;1'
<br /> and Si 'A r s ti 10 'US EPA ID Number r S s � e
<br /> Q �}
<br /> �z _i640 L.
<br /> -12. Containers 13 Tota{ 14.:Unit
<br /> rV 11. Us DOT Description(including Proper Shipping Name,Hazard Class and 16 Number); No T a Quantity Wt/Vol 1 -Waste Numbet i 1
<br /> Jz c n- f - a z FT s. 'a5 e 1�z 1 >�i.f rsS •'i!fiX it �Jtl3 state
<br /> EPA/Otfied{ 6�
<br /> C"!
<br /> b."
<br /> EPA/OtherRi t
<br /> v Ar* Stats ��
<br /> c
<br /> O 0 ' EPA/011ier " Y ''
<br /> W �' >`t'
<br /> I K �r � s �' 'State �.�L:a�'f+zr�cwr.'•_���`-: .�
<br /> I
<br /> �+.�'e,
<br /> 4 u.f ✓,. .t+:°p". l s 'a -b 1 t °- ay�k, a 4" K'.Nandlm .Cod for:Wastes l sated Above r d °c
<br /> y r
<br /> - y�y ].`Addition{: scriptib For Matenafs irsied +ffove-- P'ty„y„< n;, .�y, �,. 'd7t,;'. -r i 9�"t "4 k ,.p:.
<br /> .L ;•$ {�y{,,,,"I [-'N�` i_ :.1L Sz'YN "? ', 3�'+d h' •''rIj' Fs ,�Yt v `jf -Q,i F -3c'-r -�{'.F, G= b }S' '1'�}n't�-•'.1{'--R,j F
<br /> I� J:1:G «rt1'� 1 h1 t8Y' ;'i6"a-+ '(, r.'/l 'y .s+Yi.," 1 .k`- 'r ur'r �=• ;r c
<br /> y 5. .¢ d .'rh:` 9' i'r -ap✓� �x`�ac4�-r,F; n ri
<br /> a ' .f, �'- Sr' �5r' n'�u tH! -ArzF a-r't�7. ,r
<br /> x'.�,' f� wNx ar ,, ,. ,s1' ny F All
<br /> + . F u ��. d. s i
<br /> -ate ,>oti' .�F.7 rte',,,�!'.=, '4'..Y�, r '4r r'�,y a '�..,. s. :',',`� ..' te^lai- e, F•, "''. ii
<br /> yea,`"k--?K' S '126 ,�, .-,"r"a" �x 2?:7 r 'V i'".`"'
<br /> _ t�a ,, ,3 -.'��s - as ev =Yx,
<br /> ..+ iM '- >& rrt fi `> S •.- �':,y t�v v�,.
<br /> �rd'>� �:s" '�rs,.s,-'�,..•.,,.. '�z• w�'�-- 1 �
<br /> Z dn�F rti ?k1rR�r>f1G Q� rt 1�: 4_T ! S, k
<br />'i O r 15: special HI1 r'A- ._ -. .,T
<br /> NlF1 Li �S" �� ►.�1iOG .r�S '>a Szfua F;1r ktI �cn t544�# �fl} j
<br /> z 1 al°1 C� }�C P.C3
<br /> ST4c1 'cv ,45q31-i��u x r r k k
<br /> I
<br />! d 16. GENERATOR'S CERTIFICATION: I hereby'declore that the contents of this consignment are Fully and accurately described above by proper shipping'name and are classified packed;'- u i
<br /> Q'` ;marked,,and labale8;and'are in all.respects in,proper condition For transport by highway according to applicable mternationa{and national government regulafiorts
<br /> .. f'' .�h d
<br /> Ifs am a lar a uantiy enerator,.l certify thin I Etave c program.in p{ccs to reduce the volume and toxiciy of waste generated to the elegise E have determined to be economicallyy _` 1
<br /> o- ' '.practicable and that I have selected the practicoble method of treatment,storage;or disposal currently available to me which minimizes the present.and future threat to human health. I
<br /> and the environmenr;'OR,if I'dm a smal]'quanlily generator,,)have.made.o good faith effort to'minimize my waite'generat on and soled the best waste management method that is;'
<br /> available"to me and that I can afford. �.:....'A• 1
<br /> 0 Mont l Day =Year .1
<br /> I- -
<br /> Pri!j.d/T / y- ti • - ° st,. SVgnature' w -� !,
<br /> 60�
<br /> . ,
<br /> ' 14
<br /> w T -17. Transporter I Ackho'wled einem of.Recei t a alerials - �- • '
<br /> JF oaf� Da_y ._• 'Yea' f
<br />`I p Printeded,N a £.. Si fur l �Ly _
<br /> -tl „ c y /" Q
<br /> u_ 9 16.
<br /> Transporter 2 Ackn'owled anent of Receipt of Materials
<br />{ 0 R Printed/Typed Name 77 signature Manch Day. Yeas
<br /> r
<br /> 19. Discrepancy] pace
<br /> t-' F r 'fi
<br /> Z1
<br /> 20. FacilityCtwner ar O stator Cernficaiion of recei t of hazardous mareriali covered b ilia manifest exte t os noted in Item 19
<br /> T,. Printed/Typed Name-, a 'srgnatura * Month' Day Year
<br /> DO NOT:WRITE BELOW THIS LINE
<br /> DTSC 8022A(1/99) Yellow 'GENERATOR.RETAINS
<br /> EPA 8700--22
<br />
|