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Slate of California—Environmental Protection Age nq ')Riu SR A 2 �,-f <br /> Form Approved OMB No.2050-0039(Expires 9 30 99) See Instructions on back�9e b. Departmem of Toxic Substdiices Contra <br /> Pleme print o,typo. Fwm designed/or we on elite(12pik .writer. Z ,.x nq Colgernia <br /> UNIFORM HAZARDOUS 1. Genere,oi,USSEPA IDNo. Manifest Document No. 2. Pagel Information in the shaded.,.as <br /> '^ is not required by Federal law. <br /> WASTE MANIFEST C, II �` ,3 4 w t) 4 o of <br /> 3. Generator's Nome and Mailing Address A. Slot.Manifest Document Number 23823493 <br /> ,3ENERl+E.. MILLS 3 8'2 3 4 9 <br /> --TTN. WADE BROUGETON B. State Caneraro:.ID - -- <br /> h OX 30027 LODI, CA 352411906 <br /> 4. Genere,afs Phone 120 1314- ?OgC' m-P."NCT 01TACT: BOE' 15 <br /> N S. Transporter 1 Company Nome 6. US EPA ID Number C. State T,ansponer's ID[Res_rved.] <br /> s") UNIVAR t)SA I'rtC„ D. iranaporrers Phone <br /> o CAD 0 : 0 9 2 15161 "i 408-435-8100 <br /> 7. Transporter 2 Company Name B. US EPA ID Number E. Start.Transpode/s ID IReserved.]. <br /> *V) UNI'vAR USA INC. <br /> ec (J C A k (i r) 0 4 7 S 4 n F. Transporter'.Phone n n? <br /> V 3�.3-637-<._:i7. <br /> 9.Designated Facility Name and Site Address 10. US EPA ID Number G..Stab F.ciliys ID <br /> QN?'X SPECIAL SERVICES, INC <br /> z 735 WES't JEFFERSON 5T• H. Faciliy!P1. <br /> PHOENIX,N ac AZ 85043 , 502-415-"s02L <br /> 11. US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number) 12. Cantainor, 13. Total 14. Unit <br /> ,M1v) V No. T Quantity WI/Vol I. West.Number <br /> 'V Z ..UNIVERSAL WASTE (FLUORESCEWT LAMPES', State <br /> EPA/Otte. <br /> NONE <br /> o N b.UP:i:`I;LRSAL w 5'IE ;,Ha LAMPS) .„� So-4. <br /> W E C "EPA/Other <br /> N R I C F I NOM <br /> v A <br /> o T slab <br /> m Oerre <br /> R EPA/Other <br /> w d. Stare <br /> Z <br /> W EPA/Other <br /> V <br /> W <br /> � <br /> J. Additional Oesciipridns for Materials listed Above K. Handling Codes kr Wastes Listed Above <br /> O Ila. 724901 STRAIG.T £ F'LUORESC'ENT uJI,E41?5 b. Is <br /> try ;:la.. 224901'. HID LAMPS <br /> W <br /> a <br /> Z15. Special Handling Inst clans and Additonal Information 1% -�%P t(I. i,i ra <br /> QEMERGENCY- CONTACT; C?"TP.EC' 1-800-424-9303. CALLER MUST IDENTIFY UNIVAR USA AS <br /> Z SHIPPER. <br /> W PLACARLS PROVIDED BY CARRSER./Sffi PPEI2 Y'b'.S/NO DRIVER SIGNATLT2E <br /> r 16. GENERATOR'S CERTIFICATION: Ihereby declare that the contents of this consig ernt are Fully and accurately described above by proper shipping name and are classified,packed, <br /> Vmarked,and labeled,and are in all respects in proper condition For transport by highway according to applicoble international and notions government regulations. <br /> If I am a large quand generator,I certify that I have a proggram in place to reduce the volume and toxicity of waste generated to the degree I have determined Its be economical <br /> llyy <br /> �- practicable and he,1 hove selected the Practicable method of treatment,storage,or disposal currently available to me which minimhe <br /> izes the present and Future threat t.human oltb <br /> w and the environment;OR,if I am a sma I quantity general.,,I have made a good faith Add to minimise my waste generation and select the hest waste management method that is <br /> Om.11.61e to m.and that I can afford. <br /> y Pri ed Elam sn , )�9' Signa r <br /> Z L� t G- v <br /> 1011�i] D6v� /' li <br /> U fA/' <br /> W T 17. Trans otter 1 Acknowled errant of Receipt of Mabrials <br /> �j N Printed/Typd me K�R Sign / / �{,1o.1F, D17 yYe r/ <br /> W T <br /> LL 9 18. TFbns oder 2 Acknowledgement of Receipt of Materials <br /> O R Printed/Typed Name Signature Month Day Year <br /> i <br /> w g <br /> Q 1 <br /> U 79. Discrepancy Indication Space <br /> Z F <br /> _ A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or O .rotor Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Print. /Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A 11/991 Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 8700-22 To P.O. Box 400, Sac,amerao, CA 95812-OAOO <br />