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Dtote at Lasrtornia-^cnwrommu11w+ `a73�r See insTTUCTIona urr u— Speramento,California <br /> FormApproved„OMB No.2050-0039(Expires 9-30-99] <br /> Please print or type, Form designed for use an elite 112 PirchJ h_or, <br /> er. 2 Poe 1 Information in the shaded areas <br /> 1 erators US EPA tD No. Monifest Document Mrr g is not required 6y Federal law. <br /> UNIFORM HAZARDOUS of <br /> WASTE MANIFEST fqD Z i p z Kt j 5 <br /> A. State Manifest Document Number" f] `�'�5 23 <br /> 3, Gene`�otors Name and Mailing Address _ (w <br /> s,A}�-s'S� (i.�17'S'�4'!.L'>r� �rY7i..�L e�'^L„^l <br /> U AJ B. State Generator's 11) <br /> LO A..Generotor's Phone[ j] (r�(- 0 C, State.Transporrers ID[Reserved-] <br /> N 5.'Transporter 1 Company Name 6. US EPA ID Number _ <br /> [ D.-Trans <br /> C? r ]til!- 2400 240 <br /> _ a <br /> joa <br /> O S. US EPA ID Number E. State Transporters ID[Reserved] • <br /> OF 7. Transporter 2 Company Nome t. <br /> J w:' <br /> P. Trunsporlet',s Phone <br /> a <br /> G'.SFute',Facil[tys:Ib` <br /> rens <br /> US EPA ID Number m . <br /> V d Site Add <br /> 9.'Designated Facility Name an <br /> _^a '`S 4iwi-erF w �- d. ,:+. :.ti3.�� H. Fac111ty�3,P96ne ,' .' - <br /> �.0 <br /> J, 12. Containers 13.'Total lA. Unit <br /> Q 11. US OCT Description[including Proper Shipping Nome,Hazard Class,and ID Number] No: Type Quantity Wt/Vol I- Waste.Number <br /> "V Slat <br /> z a. . <br /> F i 'EPA%QYhe�. <br /> Waste LiquJ4(TUT'5ed'Allited GIA) <br /> State <br /> E <br /> ab. <br /> gEPA/Olher <br /> o <br /> R <br /> v A State <br /> o T <br /> as O EPA/Other <br /> State <br /> W d. <br /> t- <br /> Z �. EPA/Oiher <br /> V <br /> LU °` - K. Handling Code's for Wastes Listed Above <br /> V) J.'Additional Descriptions for Materials Listed Above <br /> 6. <br /> 0 _, b <br /> V) c.d . <br /> a <br /> O -15. Special Handling Instructions and Additional Information <br /> LU <br /> F- <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 /> d, <br /> marked,and labeled,and are in all respects in_proper condition for transportby highway according to applicable international and national government regulations. <br /> U <br /> I#I am a large quantiy 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 to human eolX <br /> practicable and that I have selected the ractica6le method of treatment,storage,or disposal currently available to me which minimizes the present and future Ihreat to human health <br /> pp <br /> and the environment;OR,iFl 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 /> n available to me and that 1 con afford. <br /> 0 c Month Day Year <br /> 'Printed/Typed Name r r"'•. _ - Signature,,,T .Y �! �_ -.� „•,•1,---- p <br /> 1✓1 r <br /> T LU <br /> 17. Trans orier 1�Acknowled ament of Recei of Mnlerials - ° 's <br /> c' A Pri q/ nped�7Name s - Signosur. �' - Month Day Year _ <br /> LU <br /> P <br /> LL 0 1 B. Transporter 2 Acknowledgement of Receipt of Materials Month Day Year <br /> 0 T Printed/Typed Nome Signature <br /> w E <br /> rn R <br /> V :19. Discreponcylndicalion Space <br /> Z f° <br /> A <br /> C <br /> L - <br /> 20. Faciii Owner or Operator Certification of receipt of hazardous materials covered by this manifest exce t as noted,in Item 19. <br /> I <br /> T ;Printed/Typed Name :. � Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> Blue, GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DTSC 8022A 11/99) To: P.O- Box 400, Soeramenio, CA 95812-OA00 <br /> EPA 6700-22 <br /> .k . <br />