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ornia--Environmental Protection Agency r See instructions on back of oar �. Department of Toxic Substances Control <br /> ?d OMB No.2050-0039(Expires 9-30-99) Sacramento,California <br /> P. type. Form designed for use on elite f 12-pitchJ _ <br /> . venefalor's US EPA ID Na. Manifest Document No. 2. Page 1 Information the shaded areas <br /> 1 <br /> UNIFORM HAZARDOUS ;5 not requsred by Federal law. <br /> WASTE MANIFEST 9 i� 3�: + OF <br /> A. State Manifest Document Number <br /> 3. Generator's Name and Mailing Address .- s t"f; <br /> ,m� Pat <br /> i-I'.i:,.� a''7,.s: `r r�a',f 5.77': <br /> ` B- State Generator's ID <br /> LO <br /> t� <br /> LO <br /> NC. State Trans orter's ID[Reserved.f <br /> N <br /> S. Transporter 1 Company Name 6. US EPA ED Number P <br /> T D. Transporter's Phone <br /> o .. ,a . '_. . - . <br /> 7, Transporter 2 Company Name S. US EPA ID Number E State Transporter's ID[Reserved.[ <br /> J F. Transporfer's Phone <br /> U 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Futility's ID <br /> Qati• <br /> _ .. <br /> +'+ H. facilily's Phone - <br /> .�Q i" ' L: <br /> 12. Containers 13. Total 14. Unit <br /> 11. US DOT Description{including Proper Shipping Name,Hazard Class,and ID Number} No Type Quantity Wt/Vol t. Waste Number <br /> %iZ o Stale <br /> EPA/Other <br /> el "tt 11 <br /> N ^- State s <br /> o N <br /> ao <br /> co E EPA Other <br /> A v"' D , -7<; Stale <br /> C. fF <br /> t; <br /> O T �`L40N, <br /> a�0 O ''t:f)iSt.hLa �Ca'�' YyA.1"ION 4'�FOi1 lS GI`yt',,r i1�1C(s:( i[:�ig rA;�'CE s-�)�\i, � � G1'k1 .il EPA/Other <br /> R Y-R.L1:T5 TO pCSTk"fC +' G{JlJg17:: �sCOb:_rZY :,r- _ ,VCE Wn7 < <br /> (+Ef'f st Bi0M5 State <br /> .GiY :.:{E,yC:cTi W �v-:1'O:,i !Fl{eµ+ <br /> Z d. `''STE�t,YD ALL I7-()= yy LU } S ALL OF $' NvCC.'.'SSf i? EPA/Other <br /> U <br /> W <br /> V) J. Additional Descriptions For Materials Listed Above' r i K. Handling Codes for Wastes Listed Above <br /> ZCL <br /> d. <br /> N - <br /> u1 <br /> a <br /> Z 15. Special Handling Instructions and Additional Information _~4 <br /> 3 <br /> Z SZmax'KtC7_'i. .- <br /> Z <br /> a- <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> Umarked,and labeled,and are in all respects in proper condition For transport by hig'nway according to upplicable international and national government regulations. <br /> �_ If I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> C practicable and that I have selected the racticable method of treatment,storage,or disposal currently available to me which minimizes the present and Future threat to human he <br /> N <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 /> 44 available to me and that 1 can afford. <br /> OPrinted/Typed Name Signature yPt .i Month Day Year <br /> Zj fy` �1 s 1 If.✓I 4 1 i// s t••1 f,l %7 r. tr �! <br /> LU r 1 Acknowled T 17. Trans ortegement of Rece't t of Materials <br /> W R5i nature ! Month Day Year <br /> LU F Printed/Typed Name Jr g fX, ,ip p <br /> w P .- <br /> 0 °18. Transporter 2 Acknowledgement of Recei t of Materials ��` • ( +� <br /> O E Printed/Typed Name Signature f Month Day Year <br /> vl R # <br /> (Qj 19. Discrepancy Indication Space <br /> Z A r <br /> L <br /> I 20. Facili Owner or Operator Certification of receipt of hazardous materials covered b this maniFest except as noted in Item 19, <br /> T Printed/Typed Name Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow- TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> (Generators who submit hazardous waste for transport out-of-stole, <br /> DTSC 8022A(1/99) produce completed copy of this copy and send to DTSC within 30 days.} <br /> EPA 8700-22 <br />