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Stale of Cal ifornlo—Environmental Protection Agency <br />Form Approved OMB No, 2050-0039 {Expires 9.30-99) See Instructions on back of 06. Department of Toxic Substonees Control <br />Pleuse print or type. Form d&signed for use on elile ( T2 -p"0111) rypewriler. <br />DTSC 8022A 1119'?) <br />EPA 8700-22 <br />ZTO 1n <br />DO NOT WRITE BELOW THIS LINE. <br />Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />To: P.O. Box 400, 5ocromento, CA 95812-04OIJ <br />X8d Lf:00 9TOZ/6T/rO <br />1 Generator's <br />aacromento, Calitornio <br />US EPA ID No. Monifost Documenl <br />UNIFORM HAZARDOUS <br />No. 2. Page I Information in the shaded oreos <br />WASTE MANIFEST CA L f] D O <br />4 not required by Federal low. <br />1. 5 b? 7 6 2 8 <br />1 of <br />3. Gonerotor'e Name and Moiling Address <br />707TE. oT <br />? 0 ? E ROTir <br />A. Stale Man DocumaM Number <br />2 51 0 7 3 4 8 <br />sees <br />. RU . <br />rseln�eCr ifor �� �Q a 5 231 <br />B. Stain Gonoralor's ID <br />s�PFoni I <br />— <br />5. Transporter 1 Company Nome 6. US EPA ID Number <br />C. Stole Tronsporier's-ID [Reserved.] <br />on <br />CD <br />SHOP HAZARDS SOLUTIONS C }t 0 p 0 Q 6 � � � � � <br />D: Tran sport. Phone <br />co <br />r <br />7. Transporter 2 Company Name <br />P P Y 8, US EPA ID Number <br />j <br />E, Stole Tronsporter's Itr Ros ry ,1 <br />J <br />VF.-'Transportor's <br />' <br />Phone <br />9. Designated Facility Nome and Site Address 10. US EPA ID Number <br />G. State Fpai jly'e 7 <br />GT' M— CORD OVA S..T,C _ <br />Z <br />O <br />11855 WIFTE ROCK RD . <br />H: Focillfy's.Pliona <br />J <br />PAVC80 CORDOVik, r <br />13 <br />�. <br />Q <br />V <br />11. US DOT Dascri tion (including Pro er Shi m Nome, Hazard Gass, and ID Number <br />P ( 9 P PP 6 ] <br />7 2. Containers <br />13. Tatol <br />16. Unit <br />No. <br />Type <br />Quantity <br />Wt/vol <br />i, Wade Number ' <br />Z <br />a. <br />A SORBE1VTS, OIL & DIESEL <br />State352.223. <br />G <br />BI014-RCRAi RAZ.ARDOUS TOASTS SOLID <br />EPA/Other . <br />non-rr-ra <br />E <br />0 0 2 <br />D ISI <br />O 8 2 w <br />P <br />N <br />state <br />E <br />yR <br />EPA/Other. <br />e <br />A <br />j`" <br />T <br />Stela <br />:o <br />O <br />sc <br />Q. <br />EPA/Other <br />u <br />d. <br />�\ <br />:Slate <br />T <br />u <br />J <br />" <br />EPA%Other <br />u <br />y <br />I�rf�?,tiLddifla�tt.'V((air',DT�g,[jCs�c�rpiflO`os'�far Mafmibli'll:�od, A$ove �`:hf7L At !:fll �l,a��4^"cjiy±.�IJ'7�"r�i1'�t�lll'J �I»I1.4f7 i7K�.1:�'I1PtlalmgCode>, <br />1' �.p •.t 'Ir171r, <br />fbr Waslns.ljslOdAbOvB; <br />1�7L7i1�"'1"YTr7-�;""'T r•f *� <br />Ii �il�+G�" 1 ISr ,.ji .I r�.j1 �I t • •e4L`�7 i� 1 <br />:' l.�r: <br />114141 l IA. til} ,�� JII pro <br />?'..rr, !] � ; ldf �� ./v , <br />i t,i.l�, r ,r;•>:! <br />•d. <br />t <br />"v, _ "�`T, <br />r-_ rf.�,41 L I• <br />.. <br />IS. Spacial Handling Instructions and Acidilionol Information <br />APPROPRIATE PROTEC'TIt7E CLOTHING <br />"'EMIRGENCY CONTACT: (800) 746-7449" <br />SEE E.R.G. PAGE # 171 <br />16, GENERATOR'S CERTIFICATION: 1 hereby declare that the tonienls of Ihis consignment are fully and accurately described obove by proper shipping name and ore elassilied, pocked, <br />marked, and labeled, and are in all respocts in condition for transport highway international <br />l <br />proper y according to applicable and nations govarnmont regulations. <br />i <br />! <br />If I am a large quantity generator, 1 certify that I have a preggrom in plow to reduce rhe volume and foxlcl1 of v asta generated to the degree I have determined to 6o ocono,nieoll <br />proetieo6la and that I have selected the peoclica6le method of treatment, storage, or disposal currently available to me which minimizes the Future threat to human health <br />present and <br />and the environment; OR, if 1 am a small quantity generator, I hove mode o good Faith effort to mini waste generation and select the best waste management method that is <br />available to me that I <br />and can afford. <br />lV <br />Prjntad/Typed Name v r <br />Signal re <br />Month Da Ycar <br />T <br />R <br />17, Transporter 1 AcknowIgd pment of Receipt of Materials <br />A <br />Prinhad/Typed Nama <br />Sign Ilo <br />Month Day Year <br />0 <br />19. Troms erler 2 Ack„awled a m of Rea i t of Mclerio6 <br />T <br />1 <br />P <br />Printed/Typed ed <br />YP Nome <br />Signotura <br />MoDay Ycar <br />E <br />71nth <br />R <br />1 <br />19. Discrepancy Indication 5poce <br />F <br />A <br />C <br />I <br />L <br />1 <br />20_ F citily Owner or Operator Corlificotion of recei I of hazardous materials covered by this manifest except as noted in Item 19. <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />Y <br />I <br />--L -.I <br />DTSC 8022A 1119'?) <br />EPA 8700-22 <br />ZTO 1n <br />DO NOT WRITE BELOW THIS LINE. <br />Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />To: P.O. Box 400, 5ocromento, CA 95812-04OIJ <br />X8d Lf:00 9TOZ/6T/rO <br />