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Stole of California—Environmenial Protection Agency S@@ ructions on back of_QG, 1. Department of Toxic Substances Contra <br /> Form Approved OMB No.2050-0039(Expires 9-30-99) - w Sacramento,California <br /> r <br /> Plegse print or�,type. Form designed For use on elite f 12-pitch] 2, Pae l Information in the shaded areas - <br /> 1. Generator's US EPR 1D Na. Manifest Qocumenr t._.` 9 <br /> is not required by Federal law. <br /> UNIFORM HAZARDOUS rpp• i 7- 1 � of <br /> WASTE MANIFEST rJ <br /> h {1��: EMIR C A. 51ate Manifest Document Number <br /> 3. Generator's Nome anti Mailing Address C <br /> i; �✓ B. Stole Generator's 1D <br /> h LO A. Generator's Phone fAyt;9 ) s-+stj"SZ: o t'A+'11, wot <br /> ill I ET' E t mom? 6. US EPA ID Number C. State Tronsporter's ID Reserved.] <br /> 5. Trans f- A J"' <br /> [ j 9' €� •F *-1' U D. Trans <br /> CP <br /> O. B. US EPA ID Number 'E:,State Trarisporier.'ys-ID,IRes&-d.) <br /> 00 7- Transporter 2 Company Name - <br /> TranspaHe"r'i Phone;. <br /> Q 10. US EPA ID Number G::-State Facility s•!D <br /> 9. he sigq a�ted F�cilitXjgame ond�5tfe_AdS <br /> 3 d !Pal r ler 1`3C tV_� <br /> z Par ,er, Ca. 93643 C ALO 0.0 102-7 5 1 <br /> a <br /> 3 J 12. Containers- - 13. Total 14. Unit <br /> r U <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/vol I. Waste Number <br /> State <br /> py EPAIOthgrT�p� <br /> 3 t(f mp <br /> State <br /> E <br /> o Nb. <br /> 00 E EPA/Other <br /> i R <br /> vA Stare <br /> c. <br /> I' m 0 EPA/Other <br /> R <br /> State <br /> i w d. <br /> r - <br /> Z EPA/Other <br /> LW <br /> V <br /> 3 cos K. Handling Codes for Wastes Listed Above <br /> «i 1. Additional Descriptions for Materials Listed Above <br /> Z <br /> o .a rt" Cott,..�.Ok,0 01 <br /> N b. <br />{ <br /> j F <br /> UJ c d. <br /> a - <br /> Z 15. Specialn tr ddi' q Ii for 1-,NV �1�ls tyt y RESd s.rNSE:- <br /> Z <br /> n Joaquin Fiftcr ��u�rc�iz�g (559)498-0240 <br /> W <br /> 1 Qct"1 c-c t�.s .:�►a+ <br /> l 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurate)y described above 6y proper shipping name and are classified,packed, <br />{ V marked,and fo6eled,and are in all respects in proper condition for transport by highway according to applicable international and notional government regulations, <br /> if l am a large quantity generator,1 certify that I have a program in place to reduce the volume and toxicity of wrote generated to she degree I have determiner!to be economically <br /> CL practicable and that I have selected the practicable method of treatment,storage,or disposal currently ovoilable to me.which minimizes the present and future threat to human health <br /> 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 <br /> CX ovoilable to me and that 1 can afford. <br /> I O Prince ,Tmed Name Signature Month Day Year <br /> z1r ­ <br /> w T 17._Jran otter 1 Acknowled ement of Recei t of Materials ! <br /> ' Month Da Year <br /> �' A Ppmte / yped Noma l Signof �', r y'1 <br /> w R - x_� �C✓ 3 01 C1,6 <br /> w P <br /> W 0 18, Transporter 2 Acknowledgement of Receipt of Materials <br /> Q T Printed/Typed Nome Signature . <br /> Month Day Year <br /> r Us LLJ E <br /> R <br /> V19, Discrepancy Indication Space, <br />+. Z F <br /> A <br /> C <br />{ <br /> 20. Facili Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Pay Year <br /> Y <br />' DO NOT WRITE BELOW THIS LINE. <br /> s <br /> Blue: GENERATOR SENDS THIS COPY TO DISC WITHIN 30 DAYS. <br /> DTSC 8022A (1/99) Jo: P-O. Box 400, Sacramento, CA 9$812-0400 <br /> EPA 8700-22 <br />