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Slate of Colifornio—Environmental Pmtection Agency Form ApPm.J OMR No.2050-0039(Expires 9.30991 See Instructions on back of -sa a 6. Department Department of Toxic Substances Cunlrol Please print or type. Form designed For use on elite(12-pikh 'i"'. Sr03j Sacramento,California UNIFORM HAZARDOUS T. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Informafian in the shaded areas snot required by Federal law. WASTE MANIFEST ICIA41 6161c,101011 IS f0 I S i of r 3 neroro/s Name and Mailing Address Stab Man fest Dowment�Nnmber 7 [SAj R ,.ties�<.6� :1-nc �R tae/ ; c � 98081455. € 0 -s9� ! V/7�� A./t LQ A+C.e/� y �l�.Lil G Smta Generator's ID - ul !. Generator's Phone I 1 � -... (J sesN 5. Transporter 1 Company Name 6. US EPA ID Number C..Stare Tronsporrer's ID -- ul .w 8 . DSAITRANSPORTION P. TransporresPhone 1$ 101-799 7924 ' tL 7. Transporter 2 Company Name 8. US EPA ID Number E. 51ale.Transportr,V D seer— Q F. Transpormr's Phone ^:T i '.S I LJ'V G. Slate FapL 's ID c arae and Sim Add.... 10. Us EPA ID Number 7 L d E'Rh,`PP `St��9It8�. f4Q o, o �0 6 3 255 PARR BLVD H.:Fac I ry y.Phonp .mooRICHMOND. CA SMI IDIO 0191459A-235 1393 C Q 12. Conminers 13. Tocol 14. U°n U I1. US DOT Description lincluding Proper Shipping Nome,Hazard Class,and ID Number) No. T e Quantity Wt/Vol L Waste Number CU= ASTE EMPTY STORAGE TANK j 5t sts ti. G on-RCRA hazardous waste solid TP P EPA/OtharN E Q101 I it log dO ONE: o N b' slate m E R ,EPA/ocher vA a lam 0 . T m R #PA/Other u_ d. ;Sro1e �eZ W U I EFP.FCthnr ' — _ O Yi t'v v, av� 'y g6dJhl�fgr00deafo N e L z ec Above see d. S i 1 Ha dbn I tree! and Ad amna(Irrformafi n / err apprdpnafe prolective clothing when handling. SITE LOCATION: T Z 4 Hour Emergency Telephone Number:�'-3 -1�/O� 9.x 7 ? tc-1c- ,+ Hour Emergency Contact: LCc i CA gs2yc, ERG 179 =+ 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment aro Fully an daccuralelydescribedabovebyproper ship ing name and are classified,packed, Q marked,and labeled,and are in all respects in proper condition For transport by highway according to applicable intsmadonal and notionaPgovarnment regulations. J If I am a large quan8y generator, certify that I hove a prrsgram in place fo reduce the wlume and toxicity of wash generated ro the degree I have determined to be economically w procticable and drat I have selected the practicable method of treafinenf,storage,or disposal currently available to me which minimizes the present and Future threat ro human health and the environment;OR,if I am a small quantity generator, I haw made a good faith effort to minimize my waste generation and select the best waste management method that is J available ro me and that I can afford. 17 Pri md/T Name Signa Month Day Y 'Z c d3 Z W T 17. Trans rror 1 Acknowled nmenf of R ai f o Materials V R C1 /Typed Name Sign Month Day Year P P9✓ re d 3 W 8 18. Transporter 2 Acknowledgement of Receipt of Materials O f Printed/Typed Nome Signature Month Day Year u F C R `) 19. Discrepancy Indication Sp.. Z F _ p c I L see, 1 20. Facility Owner or Operrow Certification of receipt of hazardous materials covered 6Z this manifest except as noted in Item 19. T Printed/Typad, NDama 5ignoNre - _ 0 Month 'DI Year 13 e,e DO NOT WRITE BELOW THIS LINE. )TSC 8022A 14/971 White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. :PA 8700-22 To: P.O. Box 3000, Sacramento, CA 95812 e.