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<br /> DegartmentoFToxic Substances Control,
<br /> v State of Gliforiia-Environmental PfotechOn Agency Sacramento,California i
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<br /> Form p ppoved OMB No.2050-0039(Expires 9-30-99) �, ter. "`
<br /> Pleas e prlr,i type. Form designed for we'on elite(12-pitch} 2:
<br /> page 1'-,- : Informafion in the shaded areas
<br /> 1. eeerator's US EPA 1D Nd. Manifest Document $ isnotrequired by Federal law-
<br /> UNIFORM HAZARDOUS rr ` of
<br /> WASTE MAWKSF .> , A. 2 7 a 4
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<br /> A. Genera(or's Phone gg Y ► k H
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<br /> b. US.EPA ID Number 'rte q YrxR
<br /> 5. Transporter 1-Company Name ' r�
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<br /> EsStaleronxportePs'FDRearvei3J : ,.. ,., ''r' i
<br /> I` aU 7. Transporter 2 ompany Name 8 US EPA Ip Number 1,5141 -
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<br /> 10 US EPA ID Number G yState Fac,ldy S 1D �
<br /> 9. Designated Facilify Name grid Site Address} - f wMg`x'c f,,'AVZ PICT..r A'S0.SA ". 'T 1rS Jr �LL t:' F'1-rFPF114YFla'hBr�'"Ef.'+�''",Hxhy`1-"Ly,�+"wyk' fes' tp92,"
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<br /> -12. Containers 13; Total 1d• Unit 'is};, -�����' r�,
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<br /> 11. US ROT Description(including Proper Shipping Name;Hazard Class and Ip Number]' No. T pe: Quanfily. Wt/Val 1 Wecte t fumbdr 7
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<br /> 1._AddiiibnaF'Qescr7"tioni For ihataria ,s1 Above n e mxtx r r.., :.
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<br /> T 5.-Spacial Handling Instructions arid,Addiiionaf InForrriaiion
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<br /> 1 - 16: GENERATOR`S CERTIFICATION: I hereby declare that the contents of this consignment are Fully and accurate i described above by proper shipping name and are dass,fied pocked
<br /> Q marked,and lobeled;and are in all�a-spects in proper'cond'stion,for transport by highway according to opplicoble_mternahonak and national government regulations
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<br /> 1 _ hiaye a-ro Yam in lace to'reduce1the volume and toxicily0F waste generated to the degree I'-have determ,i,ed to,be economical! 'r
<br /> l IF I am 6.1arge,quontily generator I certify that I p g P yy
<br /> practicable and that I hhave selected'the p'racticabl'e method'oF treafinent,'storai3e,.or,dispasaI c%irrently.dvailable to me which,mirimnizes'the present and future threat ro human,heolth
<br /> and the environment;OR,if E am a email q'ubntity generator,1. a3e'made a good-faith 0FFait to'ininimiie,my waste genera(ion end select the best waste management method that,t_
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<br /> available tome and that 1 can afford
<br /> Prfnled%Typed Name. Signotur a Month' Day Year e
<br /> iJJ T, 17. Trans orter 1 Acknowle ement oflRedei'1 of Malerials
<br /> I o. A Printed T' ' Name S,gnatu Month.r Doy rYeur
<br /> ''-LL. p 1 S Trans6orter 2-Ackn6wled ement of Recei it of Materials - Month .Day'- 4 ' Year
<br /> �0 .T Printed/Typed Name' 'k; Signature.- 1
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<br /> Q R M 21 1
<br /> �V19- Discrepancy'IndicationSpace .� �
<br /> -20. Facile Cswner'or0 stator Certification of recei~rof hazardous materials covered b this moniFest as noted in.ltem 19.
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<br /> T' Printed/Typed Name Signature -
<br /> MDnth Ray Year'
<br /> i q'O NOT:.WRITE`BELOW THIS,LINE
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<br /> DTSC 802A(1/99) ' ;Yellow GENERATOR RETAINS
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<br /> EPA 6700-22 -. t
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