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Slate of California—Environmental Protection Agency See'Instructions on back of,Rot, Department of Toxic Substances Control <br /> Dep <br /> T► 'Sacramento,California <br /> Form Approved OMB No.2050-0039(Expires 9.30-991 p -iter. <br /> Please print or type. Form designed for use on elite 112-pitch) Manifest Document h 2. Pogo 1 Information in the shaded areas <br /> 1. iienerator's US EPA ID No- is not required by Federal taw. <br /> UNIFORM HAZARDOUS # � � � � � � � of <br /> WASTE MANIFEST <br /> A. State Manifest Document Number <br /> 3. Gen rotor's Name and ailing Address /} �� ' <br /> 248662400 <br /> IS' iLb X2001.r1 2CE a B. state Generators 1D <br /> W' <br /> A. Generator's Phone(-2'2-� ).., -cs200 <br /> - C. State 7ransparter's ID[Reserved.) <br /> 6. US EPA 1b Number <br /> N 5. Transporter 1 Company Name <br /> D. Transporter's Phone <br /> d Saye,f(]:-squfu F i ter RecYdi g <br /> O u e E.'State. e <br /> C? 7. Transporter 2 Company Name - <br />�� F. Tran3portari,Phone <br /> 'Q TD. US EPA ID Number G>•Sfate.FacikVs-ID? <br /> V 9. si ated lily ame and SiS � Ir <br /> Z F&0j ur, Ca, 9'64 4 C A 1 0v 0.1 'L? 2 7 5 1 � <br /> 10 <br /> 1 J 12. Containers 13. Total 14. Unit <br /> 1 1. US DOT Description(including Proper Shipping Name,Hazard Gloss,and Number) <br /> Na. Type Quantity WI/Vol I. Waste Number <br /> State zry } <br /> a'`7(,,V�.TZl RA KaZs?.Td01 S A c S$U 3 Til 'f, 4� t4 ` La a EPA/Othe j ptI <br /> G '" - State <br /> E <br /> coN b. EPA/Other <br /> co E <br /> v R <br /> state <br /> C14 A <br /> C. <br /> O EPA/Other <br /> R State <br /> cc <br /> Uj d. <br /> r <br /> Z EPA/Other <br /> w <br /> V <br /> ,yt K. Handling Codes for Wastes Listed Above <br /> I to J. Additional Descriptions for Materials rials Listed Above- a. Q} 6. <br /> 0 1t . fact. .tiaQ i <br /> � C. d. <br /> J <br /> Z 15. Special3'lrTIUn t trpc'ttQlQ d.�.�C;3,paYl trrfit> Qitii �Il.tt`Q�.,7 .. i"`�..{.a[i� F€..°ir i�E.1 <br /> t jg L <br /> Earl Joiquin}1b-,r R--cy�ii1UP), t32% t) <br />� z ��C�cs �t£Y��.•a �rr.��.� - <br /> -.Qlck) Ck31-X1�� <br /> rNERATOR'S CERTIFICATION: l hereby declare that the contents of this consignment are futly and accurate)y described above by proper shipping name and are classified,packed, <br /> Q rked,and labeled,and are in all respects in proQer condition for transport by highway according to applicable international and national government regulations. <br /> am u large quantity generator,I certify that I have o program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economical)yyacticable and that I have selected the radicable method of treatment,storage,or disposal currently availab€e to me which minimizes the present and future threat to human healthd the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and sefec the best waste management method that is <br /> 1 a available to me and that.[can afford. — <br /> f 0 5ignoru�e 1 /l t r Month Day Year <br /> f Printed/Typed Nam w �T 17. Trans orter 1 Ackwled em�n�L t of Materials Month �Do Year` <br /> I 1 a k p h�d'Typed iJome Signet r' i i„) L..� <br /> LU S <br /> P <br /> u_ p 18. Transporter 2 Acknowledgement of Recei t of Materia s - -Month Day Year <br /> Printed/Typed Name Signature <br /> i � R ' <br />{ L)LUE <br /> R <br /> i V 19. .Discrepancy Indication Space <br /> Z_ F <br /> A <br /> C <br /> -------------------------- <br /> 20. Facili Owner or Operator Certification of receipt cf hazardous materials covered 6 this manifest-exca k as noted in Hem 19, Month Day- Y70r <br /> T Printed/Typed Name - Signature , •v <br /> Y <br /> UO NOT WRITE BELOW THIS LINE. <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> t DTSC 8022A'(1/99) To:,- P.O. Box 440, Sacramento, CA 95812-0400 <br /> EPA 8700-22 �. <br />