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Form Approved OMB No 2050-0039(Expires 9-00.9A) See Instructions on back of page 6. De mrtrro n of Toxic Sub mesems Conn,, r <br /> mems prim or tyro. Form designed for use on elite(72pirch)ypr\Iew - Sacramento,Califorda <br /> i <br /> UNIFORM HAZARDOUS I. - 'or,s US EPA ID No. Momfest Document No. 2- Page 1 Informants in the shaded areas <br /> is n......ired by Federal law. r <br /> WASTE MANIFEST CIA 010t'7171014/11.1,61of 1 <br /> 7. Generatoi s Name and Mailing Addrms,'HE t'.rT D/- T.C.fG ' A. Stab Mvtdmocum <br /> fDent Number I <br /> At'rN. <br /> G/� 92710505 <br /> n 5 �0 Ti?�1Gf iSLVA. �AdL ✓� / <br /> 8. state Gernerata - <br /> 9,0 7e <br /> 's ID - <br /> , NNK A. Generator's Phone (,f/ 1 - t <br /> m <br /> 6 5. iramporrtte``r I Company Name 6. US EPA ID Number C. Stale TrsupoRe/s ID <br /> -E.— ' Pl,oro <br /> J 7. Tromporeer 2 Company Name 8. US EPA ID Number E. Stare Transposition's iD <br /> Q <br /> U F.' Transporme!Pl. <br /> Q 9. Dessignabd Facility Name and Site Address 10. US EPA ID Number G,; a <br /> Z <br /> SO I �T'®iJ01r✓ C-{-� U S Y r/ HYD "'Y <br /> 12. <br /> U12 Containers 13. Total Id. Unit s : <br /> 11. US DOT Dedptinn(including Shipping Name, Hazard Gass,and ID Number) <br /> Z ug PNo. Type OuontNy WI/Vol '�':N�asle <br /> Nav ect2A H,1z.9.ed foals H,; z 4zauw <br /> 7 3 G �IAIAYt<�Q/ ltaSoliryG) 7 � ••� <br /> �7 lT T <br /> m N b. ^x•^Y' �f cF <br /> 62 E <br /> N Rg <br /> v A <br /> a T a '" <br /> O EPh(Otlwra . <br /> rr R <br /> w <br /> Z d - " , <br /> W <br /> U TPAf 4 <br /> w <br /> Z <br /> it <br /> Q a tit <br /> Z 15. Spttial Handling Instructions and Additional Information <br /> z y <br /> Z 2Yn f�2 ``�.[[Mf e�cnlCsi 2'e 1s 'islf «fent TEL Li✓G• i ren <br /> /T rp ntu n ErrlGA1. CG6 i., Fo W lr.2f1N LJ'N£ <br /> a. y SFr <br /> 16. GENE ATO 'S CERTIFICATION: I hereby declare that the sent"of the consignment am IuAy and accurately described above by proper shipping name and are classified, <br /> Qpacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and internmbnal laws. <br /> U <br /> If I am a large quantity gerserator, 1 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 <br /> economically practicable and that I have sekcbd the proetimbk method of neatmmt,storage,or disposal currently available to me which minimizes the present and future <br /> 1 threat to human health and the environment;OR,g 1 am a small quantity generator, I have made a good faith effort to minimize my waste generation and mlect the best <br /> N <br /> � waste mono..gement method that is available to me and that I cuts afford. <br /> Pri d/Typed Name Sign Month Day <br /> a , ,Ta G <br /> UT 17, I'mmucarbr I Ahno.dedaemem al Receipt of materials <br /> w N Month Day Year <br /> pYom / ea !g <br /> O 13 <br /> 5 <br /> W e <br /> a 18. Tram, er 2 Ackrowkd omen,o ttd t of Materials <br /> w j <br /> Printed Signatu 5 i�nQd l 'G'f 1'1 ^ (j Month Day Year <br /> w [ J " <br /> Qe <br /> W <br /> 19. DisarepcilcyIndication Space <br /> N / <br /> U F <br /> I <br /> L <br /> 1 20, Facility Owner or O rmor Certificvdon o rttei t of hazardous mmeri covered b Nfest..m't as noted in Nan 19. - <br /> T ' a /Type Name Signature j Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (7/92) - <br /> EPA 8700-22 <br />