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State of Prosection Agency <br /> form Appeased Gets No.2050-0099(Expires 9-3694) v See Instructions on back of N.A a 6. Department of Taxk Substances control <br /> Please print at-rype. rmm designed for use on time(12-pda6)rypewmer. Socramente,California <br /> 1. Gersector's US EPA ID No. Manifest Document No. 2. Page 7 Information in the shaded areas <br /> UNIFORM HAZARDOUS ,q t l ,r• r�_ `_J •L-- snot required by Federal law. <br /> WASTE MANIFEST " {•�� e <br /> L I I <br /> 3. Genera or's Name and Mailing Address V A.'$thio Mani#e Do.pas I Ndmbei r <br /> - - _ 93188402 <br /> n � _t �V' B Stare Genermo:s ID <br /> tii 6. Generaror's Phorro�(, )i'~ F. <br /> �D <br /> d 5. Transporter 7 Company Name 6. US EPA ID Number C. Stole Tmnspartels ID D" <br /> m <br /> D. Tm sparter's Photic <br /> L- T _.': r1 i :=L' r. i 800 874-4444 <br /> 7 Twinapmir 2 Company Name S. US EPA ID Number E State Transporrer's ID. <br /> :U <br /> Transporters.Phone - <br /> Q 9. Designated Facddy Name and Site Address 10. US EPA ID Number G Stab Foadeye ID <br /> 4 j:VIR !7,AJ wi:- I C A D Q 8 3 I E 6 7 _ 8 <br /> _ i I 1- I I I I I I I I' <br /> H. Facility's Phone <br /> 800 874-4444 <br /> - - <br /> 1 ' 12 13rosa� 'i: <br /> 71. US DOT Descri non indudin Proper Shipping Name,Hamed Clan,and ID Number) No Type <br /> n.. <br /> wt/v.. i. Wasie Numoer <br /> a. $tate <br /> G - .- EPA/Crier <br /> 68 E <br /> to N Is. star< <br /> R EPA <br /> � <br /> 6ao T e. store <br /> app D <br /> 11 <br /> R EPA,O'her <br /> W <br /> d <br /> Z State <br /> U EPA/Other <br /> y1 <br /> m <br /> �).. K. Handling Codes for Wastes listed Above. <br /> 6.2 <br /> W <br /> d_ <br /> a <br /> 66 15. Special Handling Instructions end Additional Information <br /> �•_—'BSC;—F"4-4L <br /> Z =� HE. D!—ERGF1?CY RESPOIs C:-a)'- :,4' 'S <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment arc fully and accurately described above by proper shipping name and are classified, <br /> Q pocked,marked,and labeled,and are in all resisters in proper condition for transport by highway according to applicable federal,stare and international laws. <br /> J <br /> ki If I am a large quantity generator, I certify that I hwe a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> Reconomically practicable and that I hwe selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> y threat to human heohh and the enviromment; OR, R 1 am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> z waste management method that is available ro me and that I can afford. <br /> , <br /> PriA.Kypd Name SignatureMo <br /> ►`. nth q I <br /> Z T 17. TraimpsMir 1 Ackfwwled emery of Receipt of Materials <br /> A i 11 <br /> Prirslede/T d Signature / - ,+ Month? palmear <br /> reee <br /> 0 18. Transporter 2 Ackennivieschmereent of Receipt of Materlats <br /> w <br /> •i r Prinked/Typed Name Signature Month Day Year <br /> D <br /> 19. Discrepancy Indication So. <br /> Q F <br /> U A <br /> L_ c <br /> 1 <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest inicerst as need in Item 19. <br /> T Primed/Typed Nome Signature Month Day Year <br /> Y <br /> I I <br /> 6. DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (7/92) <br /> ,.EPA 8706-22 Yellow: GENERATOR RETAINS <br />