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[�eSbh of Calijomia—Environmenal PretecNon Ag�sy -'" <br /> Earm Appred OMB No.2050-0039(Expires 9-30-991 `/ .See Inktrucflons on back` page b• Department of Toxic Substances Connor <br /> Meow priovnt or ype. Form deigned for uw an elite(f 2-pikh)yPe-n^rn -I - Sacramento,Calihi <br /> k 1. Generator's US EPA ID No. Manihzr Docum.ar IVa. 2. Page I Informers.in the shaded areas <br /> UNIFORM HAZARDOUS C' _� l J is not required by Federal law. <br /> [ WASTE MANIFEST + _ <br /> 3. Generator's Name and Mailing Addree <br /> U4. Generators Phone (.,;11 /I \ - j '1T`•s �� <br /> N S. Tmnpams,1 Company Name 6. US EPA ID Number Gs+3lale.Ywes ,rte R,t,.-� <br /> Mr) <br /> ECOLCG'r CCN'rRCL 'NCL'STRIES D 918, 110,110 1 7 3 393 <br /> m 7. Tmmporter 2 Company Nome S. US EPA ID Number StateisTr�go)porser'xlOr _ <br /> � F 7mmpxl.lPFhotw .,ter'' :: <br /> UN 'k me and Site Address 10. US EPA ID Number G Stub Ewhyil0 - <br /> 258 PARR aL`dOMZ N h«I tsPhone ;sP./ <br /> -235- 383 <br /> �,c rK J 4 6t L <br /> O KIiHYVIU• VH yiFUi <br /> NQ 12. Containers 13, Total 14. Unit <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) Nam Type Quantity Wt/Voi L'Waste Number <br /> �3 c Non-RCRA hazardous waste solid EPA/oth.r( <br /> ci E b. sate - <br /> ct N <br /> m E EPa/ather <br /> _ a R <br /> a A sob . <br /> o T <br /> m Q ` w (7 EPAIOther - .. <br /> _ R I J <br /> s Stab <br /> W EPA/Other _ <br /> LL' Des Vs Y�sessiiia <br /> 'e%� ' <br /> �. s .. <br /> Q ��:.. <br /> p ,�f^ss{>Mx'2lpglwtpF*3Mtti4e�dldaMvng when h.lntlllny. SITE LGCATION' <br /> Q � Hour Gmor9pn=Y Takaphwno Numkor <br /> Z 24 HoUr Emergency Conma: _ ErRG# 171 <br /> t- - <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this conignmentare fully and accurablr,described above by proper shipping name and are classified,packed. <br /> Umarked,and labeled,and are in all respects in proper condition far transport by highway according to applicable international and national government regulations. <br /> If I am is largequanttyovgenerator,I certify that 1 have a program in place to reduce the volume and toxiciy of waste generated to the degree I have determined to be economically <br /> o- <br /> practicable and that hhe selected the practicable method a treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> vs and the environment;OR,if I am a small quantity generator,I have made a good faith effort no minimize my waste generation and select the best waste management method that n <br /> Oe available to me and that I can afford. <br /> O Printed/TypedNanta Signature 1 Month Oay year <br /> �r <br /> Z <br /> W T 17. Trans orter I Acknowled emenr of Recei t of Materials <br /> ae 1 Printed/Typed Nanta Signowe Month Day Yeor <br /> f i <br /> W P <br /> W B 18. Tm.tPoHer 2 Acknowledgement of Recei t of Materials <br /> O j Primed/Typed Name Signabre Month Day ear <br /> vWf E I <br /> R <br /> U19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or O rotor CemRcation of recei t of hazardous materials covered§X this manifet esu t as noted in gem 19, <br /> T Printed/Typed Name SignaNrs Month Day Your <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A IA/971 Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />