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P Slate of California—Environmental Protection Agency <br />Form Approved OMS No. 2050-0039 (Expires 9.30-99) See Instructions on back of page 6. Department of Toxic Substances Cant, <br />Please print or type. Form designed for use on elite 112-pih41 typewriter. <br />Sacramento, California <br />t <br />d <br />r <br />w <br />Z <br />iU <br />U <br />f w <br />DO NOT W C BELOW THIS -LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />DTSC 8022A (4/97) (Generators who submit hazardous waste for Iranspsr nmol <br />EPA 8700-22 produce completed copy of this copy and send to DTSC wrn, 36 dovs.l <br />Generator's US EPA ID No. Manilesr Docume <br />UNIFORM HAZARDOUS <br />2. Page 1 <br />Information in the shaded areas <br />is not required by Federal law. <br />WASTE MANIFEST <br />lAl1 <br />13. <br />Generator's Name and Mailing Address <br />A. State Manifest Document Number <br />97251 i 58 <br />_IIVIRIr - SAF_ <br />1 <br />1217 S. 71-H ST.1.10DESTO, CA 053-39 <br />8, State Generator's ID <br />1 <br />e. Generators Phone (;(-lq l <br />1 <br />5. Transporter 1 Company Nome 6. US EPA ID Number <br />C. Store Transportei s ID <br />ILLI 'cT CL"=1J 1 3IL 10 o ;7 11 ^. q .! <br />D. Transporters Phone 2001-9176-8500 <br />7. Tranapanar 2 Company Name 8. US EPA ID Number <br />E. State Traasporter's ID <br />F. Transporter's Phone <br />9. Designated tardily Name and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />4 rV IP f32' 1 19n <br />_ _, <br />H. Facility's Phone <br />m <br />'I ❑ ; p ;7 ,i. +? - <br />7- ('r+9 <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and 10 Number <br />P lint 0 P PPi 9 I <br />12. Containers <br />13. Total <br />Ouanty <br />14, Unit <br />Wt/Vol <br />I. Waste Number <br />No. <br />I Type <br />° <br />State <br />JS--) ;IL, "19N-RCSA HAZA!?f)O IS '•AASTrE <br />?91 <br />EPA/Olher <br />G <br />LT^!! -T OnT "1014 REGULATE)\ <br />� <br />� <br />E <br />T <br />�21 <br />N <br />b. <br />slot. <br />E <br />EPA/01h., <br />R <br />A <br />T <br />State <br />O <br />EPA/Other <br />R <br />d. <br />Share <br />EPA/Other <br />J. Additional Descriptions far Materials Listed Above <br />K. Handling Code, for Wastes Listed Above <br />O <br />15. Special Handling Instructions and Additional Information <br />^'a '1—__71�'— <br />;7 <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignmsntore fully and accurately described above by proper shipping name and are classified, packed, <br />marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br />If Iam a large quantity generator, certify that have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br />and that I ova elected the treatment, disposal lo future human health <br />Practimble praoicable method o storage, or currently available me which minimizes the present and threat to <br />and the environment; OR, if I 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 />available to me and that I can afford. <br />Printed/Typed Name <br />Signalara------ y <br />Month Day Year <br />�yn <br />T <br />7 7. Tram rter ( owed errant of Recei t of Min., als C <br />R <br />h <br />Printed/Ty a e `i <br />Signature V % : <br />Month Day Year <br />R <br />S <br />P <br />v I <br />0 <br />18, Trans trot 2 Acknowled amens of RRcai t of Materials <br />RPrinted/Typed <br />T <br />Name <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />1 <br />L <br />( <br />acLi wner or O erator Certification of mai tof hazardous materials <br />covered b this manifest exce t as noted in Item 19. <br />T <br />[Eint!d/Typed Name <br />Signature <br />Month Day Year <br />Y <br />'Le- , /" I YJ <br />t / I' <br />- - <br />DO NOT W C BELOW THIS -LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />DTSC 8022A (4/97) (Generators who submit hazardous waste for Iranspsr nmol <br />EPA 8700-22 produce completed copy of this copy and send to DTSC wrn, 36 dovs.l <br />