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<Sfa� gE�Col,fq'rnia-Envlronti+enlal Proteciiprj`gg"e'�Ey '�
<br />:Fo,rh'i'ApproyodOMB No. 2050-dD39(Expire59-30-99)40 . See I115}I'tJCt10115 on backof
<br />'"'8 aia''ptint aype. Form d■s;gned kr us. on elite 112- tcbj typewriter. P e 6' Department of Toxic Substances Control
<br />Sacramento. Cvlifornia
<br />UNIFORM HAZARDOUS' ge 1 • Generator's US EPA ID No, Manifest Document No. 2, Pa1 Information fn rhe shaded areas
<br />WASTE MANIFEST is not required by Federal law.
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<br />3. Ganarolyf Name and Meiling gdelress A. Slate Manifest Document Number
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<br />8-..5tote Generolar's ID.
<br />4. Generolo/s Phone
<br />iV 5, Transporter 1 Company Nam. 6, US EPA ID Number G, 'Stale Trortaporwr's ID Rdervod,}
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<br />'CJ 1-I ,? .F ��. :] K4 '•� D. Transporter's Phone .
<br />7. Tramporfer 2 Company Name 8. US EPA ID Number E.' State Trarisporter's ID [ eee� J:
<br />F, Tronsporter.'s Phone
<br />9. Designated Facility Nome and Site Address ID'. US EPA ID N
<br />!,`;';s•Y,�ril�t,••_7Liti,}IrJ�.r1 umber 'G, State Facility's ID .,
<br />H. Facility's Phone -
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<br />V t 1, US DOT Description (including Proper Shf in Name, Hazard I 12, Containers 13. Total jd. Unit
<br />0 oP PP 6 Cots, and 1D Number)
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<br />No. T Quantity-Wf vol h .w i•..
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<br />-7' J, Additional Descriptions far Materials Usled'Above
<br />' K. Handling Codes for Wostee Listed Above
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<br />0 15. Special Handling Instructions and Additional Information
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<br />16, GENERATOR'S CERTIFICATION: I hareby declare that lila contents of this consi nmenf are fvlly and accurately described Above by propershipping nacre and are classified, pocked,
<br />V marked, and loomed, and are in all respects in proper condition for transport by highway according to applicable international and notional government regulatlam.
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<br />d If I am a large gvonfi generator, I certify that I have o program in lace W reduce the v
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<br />P g P glume and toxicity of waste generated to the dmgrmp I have determined to bg r,canamically
<br />U) prooicable and that I eve selected the prvaficable method of treatrnenl, storage, or disposal currently available to me which minimizes the prosant and Future ihreal to human health
<br />and the .nvjranment; OR, if I ern a small quantity generator, I have made o good Faith effort to minimize my waste gonerallon and select the best waste management melhad that is
<br />0 avoilabfe to me and lhof 1 can offord,
<br />y Printed/Typed Name i
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<br />b gnature
<br />U ,✓ i M"w .ti Month Day Year _
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<br />(j R 17. Trans ort4r 1 AcknowTpd 'entent of Ramiet of Materialsthe .r-� " " _ -•1'.: _
<br />LLJN Printed/T�pad Name - Signature Month Day Year
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<br />W P �. f{!. � x. 3 � 7i,r ..r:�: f yr v,+ d" a � j . ��,� '�•'rltis" .rr , -p'f� sY' e% 7^I
<br />0 e 18. Tram atter 2 Ack"rtowled emanl of Receipt of Materiala
<br />Y Prinlad/Typed Nome
<br />LLJ F Signature Montt Day Year
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<br />U F 19. Discrepancy Indication Space
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<br />f 20, Focili Owner or Operator Certification of receipt of hazardous materials covered b this manifest exec t as no in Item 19.
<br />YPrinted/Typed Name Signature Man16 Day Year
<br />DO NOT WRITE BELOW THIS LINE.
<br />DISC 8022A (1/99)
<br />EPA 8700-22
<br />9TO in
<br />Yellow; GENERATOR REI'AINS
<br />YVd Sig:00 9TOZ/6T/b0
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