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<br /> stole of CalifoEnvironmental Protection Agency [1 ti
<br /> DepartmentSacof Toxic Substances Control
<br /> " tee Instructions on back of p Cj Sacramento,Ca4iEarma
<br /> Form Approved C)M8 No.2050-0039!Expires 9 30-99) 4;-
<br /> Please-prmt'or_Type. Form ciesignecffor'use on efife f 12-pitch)f, iter. -
<br /> 1. Generator`s U5 EPA!D No`: Manifest Document No.'' 2. Page 1 -` Information in the shaded arevs
<br /> is not required by Federal law.
<br /> UNIFORM HAZARDOUS
<br /> WASTE MANIFEST
<br /> r A State Mar rfest Document Namber- 6
<br /> 3. Generator's Name and Mailing Address Nt. Am: Pat Guillariil ��y�� ptik '� � 37
<br /> Unified Western Glwers
<br /> S11t11a t(J^ Qt 8 Stole Generator s ID u �s �,p�h
<br /> hJ C�GIZ'�mDr „C :x ' !tq e' 4z I
<br /> 4. eneraior s one " 5 _ -
<br /> x
<br /> 6. US EPA ID Number, C State Transporter's ID[Reserved x x
<br /> l+E 5. Transporter 1 Company Name •art, +' ^F'/ - - - _
<br /> � r1� p/� �}�p D Transporter SP hone� - 7
<br /> 07
<br /> m H Mat Trans. } E' State Trans otters ID Reserved l s, !_ %N ` -
<br /> 7, transporter 2 Company Name 8. US EPA ID Number L p 4 � m- rY
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<br /> iranspa tar sPhone- fw y +s' M� r ri xa
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<br /> I Q G State Facility s lD - s ry ^ F -y4
<br /> 10. US EPA ID Number
<br /> V 9. Designated Facility Name and Site Address , s a s + #
<br /> Z3&50 E `ti'I Street ++� t.{ H Facilely s Pho nery� -
<br /> 1'. 0 V3 01313 1
<br /> ,rte 12. Containers 13. Total Id. Unit
<br /> r rU 11. US D07 Description!including Proper Shipping Name,Hazard Class,and ID.Number) No. Type Quantity -Wt/Vol 1- 'Waste Number .
<br /> �.�!�.1 `-
<br />' � l5st�l1 � t�f
<br /> Non-RCRA,Hazardous S/V:�lste �� : . �
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<br /> w r Sy Y $- �, ' ''K'''liorrdlrn ;Codes fol Wa;les listed Above
<br /> I rrJ.rAilditiooal'Uesc�iptions For,Matencli Liited'Abvve i- -t y 1 r, y y '�i iW fr �A 1 g
<br /> Zk :�:, -,r�_ .;. ,;fy}..r,.',yi+�y u..{?-i:,r? u-,r-was-' r�f�*�,yrx} p.•'�Sq ,5i a > i't-:6 ri-"'+??;,. '' ,i '�nr -- "r ''
<br /> �7, Clll�dil ctset;� rint t?roflleT+ G 1i F t:05 r x r r s . A ",,$'-. ,��rr g,t y _ s �t
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<br /> Z 15. Special Handling Inslruchons and Additional Information / � � {'
<br /> GlnstH3 & f,�agclt�� � ,- jiob Slt Stoc:kt.ean, GA.
<br /> i?�3fi_P�ce��la R .
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<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 /> v
<br /> Q marked,and labeled,and are in all respects in proper condition For transport 6y highway according to applicable international and national government regulations:' l
<br /> If I am'o large quontiy generator,I certify that I have o program in place to reduce volume and toxicity of waste generated to ties degree 1 have determined to be human heal)y 3
<br /> a practicable and Yhat,l have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and furore threat to human health
<br /> - and the environment;OR,if I am a small quantity generator,I have made a gaud faith effort to minimize my waste generation and select the best waste management method that is
<br /> available to me and that I can afford.
<br /> O Printed ypad Name - �. Month Day Year
<br /> Signalurer
<br /> w A 17. Transporter 1 Acknowled ement of Recei i of.Materiafs '
<br /> A. Pri d Typed NgYne Si nal ra
<br /> X _ Month Day- - Year
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<br /> .O 0 18, Transporter 2 Acknowled emeni of Receipt of Materials
<br /> R .Printed/Typed Name gnature -Month Day Year
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<br /> f Q 19. Discrepancy Indication Space
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<br /> 1 — A
<br /> 4 1
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<br /> 20. FacilityOwner or Operator Certification of receipt of hazardous materials covered b )fits manifest exce t as noted in Hem 19.
<br /> Printed/Typed Nome . . Signature .,, Month Day ' 'Year -
<br /> A DO NOT WRITE BELOW THIS LINE.
<br />{G DTSC 8022A (1/99) - Yellow: GENERATOR RETAINS
<br /> PPA 8700-22
<br />
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