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Farm Approved'OMB�No.2050-0039(Expires9-30991 See Instructions On beet `f page 6. Deportment of Toxk Subsmoces Cc- <br /> Please print or type. Form designed far use on efie(I 2 ypewriHr. Sacramento.Calilorr <br /> UNIFORM HAZARDOUS Generator's US EPA ID No. Manifest Docume 2, Page 1 Inlorni In the shaded area: <br /> WASTE MANIFEST C l- I I 0� 0 '1 Q / it not regained by Feeerul m. <br /> l/ v `-' W of <br /> 3. Generators Nome and Mailing Address A. State Manifest Document Number <br /> � IV�O�1C� y�T�J�P�nl1 22700886 <br /> (1 <br /> h <br /> ill <br /> S' l P 1 1�{pS B. Slate Generator's ID <br /> h 4. Generator's Phone <br /> n Ibq <br /> N 5. Transporter I Company Nome 6. US EPA ID Number C. Slate Tramporler's ID IReserved.l <br /> h <br /> m —_ <br /> _ 7. Transporter 2 Company Name A. US EPA ID Number E. Slate TranspoMr's ID(Reserved.) <br /> 00 <br /> J s F. Tronsporter's Phone <br /> Q _ <br /> Q V 9. D. mad Fadlity Nome and Site dd ass 10. US EPA ID Number G. Stat acility' ID <br /> O 7945ZJi it <br /> ri Z `C"i 2 H. FacysPhone S IL _ <br /> NQ12. Containers 13. Total IA. Unit <br /> U I1. US DOT Description(including Proper Shipping Nome,Hazard Clots,and ID Numbed No. Type Quantity Wt/Vol I. Waste Number <br /> Z is ^In�J — L S ` uI. Slat. <br /> 3 G ( 01111 b 'I'{I A _ _ l//' I 70 <br /> 0 Q EPA/Other <br /> o N b. State <br /> m E <br /> C R EPA/Other <br /> a A <br /> T state <br /> O <br /> W O <br /> R EPA/Other <br /> aa d State <br /> I <br /> Z <br /> 11e <br /> V rher EPA(O <br /> w <br /> J. Additiolna/l Descriptiioon�s foyM`at�eI is Listed Above - K. Handling Codes for Wastes Listedf Above <br /> be <br /> N 1 <br /> F <br /> lr,(Y�tsc'�if t• 1 <br /> Z Sit 6cling Instructions and Additional Inform lion ''••Ww <br /> rvtoo (S <br /> Z Erna enc �� Yone ` <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and aeeuromi described above by proper shipping name and are classified,paceeo <br /> Vmarked,and labeled,and and are in all respects in proper condition for transport by highway according to applicable international and national government regulations <br /> III am is large quantity g.nerator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be econo—a::::, <br /> pra:!icab!e and!hu': o. >.ctcd tl :aticvb a mil treattnenl,storey.,a,disposal carrenlly avui'.bl.iu me which minimizes the present and future mreat io human nem r <br /> m . <br /> and the environment;OR, if l yam a small quantity generator,I have made a good faith effort to minimize my wash generation and select the best waste monogemmn method Iha, <br /> ac available to me and that I mn afford. <br /> OPrinted T ped not r Month Day tee2Z 4 : <br /> Z r' ry a I <br /> w 1 17. Trch,pprer I Ahn wlad emanl of Re<si I of Materials <br /> 7 p — <br /> Ce A Prinled/TySignal." Mont`h/ Day c e <br /> 2 <br /> w P <br /> O <br /> m r e 18. Tra2 Ac nowt emont of Racer t of Materia6 _ <br /> R Pnnsed/Typed Name Signature Month Day e <br /> Lia E , <br /> H R <br /> U19. Discrepancy Indication Space s <br /> Z F <br /> A :.. <br /> C <br /> I ; <br /> L _. <br /> 1 20. Focili Owner or O rotor Certification of receipt of hazardous material d by this manifest except as noted in Item 19. <br /> T ed/Typed Nome i aWre Month Joy <> <br /> PAT <br /> DO NOT WRITE BELOW THIS LINE. <br /> e <br /> DISC 8022A(1/99) Green <br /> EPA 8700-22 <br />