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k <br />D <br />B03: <br />a <br />Form Approved OMB No. 206tN0039 (Expires 9-30-91 <br />Toxic Subatarce3 Gomr01 UIVLSI01 <br />Sacramento, California <br />DHS 8022 A (1/88) <br />EPA 8700-22 <br />(Rev. 9.88) Previous edition$ are obsolete. <br />Do Not Write Below This Line <br />Blue: GENERATOR SENDS THIS COPY TO DOHS WITHIN 30 DAYS ' <br />To: P.O. Box 400, Smramento, CA 95812-0400 <br />UNIFORM HAZARDOUS 4y �g jTfor'& US EPA ID No. Manifest . <br />`V/'` U y Z 0 7 Documant.No.- <br />2. Page 1 Information M the shaded areas <br />by Federal law. <br />WASTE MANIFEST174of <br />is not required <br />3. Generator's Name and Meting Address <br />a to K: sso�1 <br />a ta. ,r.: <br />1. Gene al/t`/4'g!W_fj Ll Iuy' <br />t <br />6. Transporter 1 Compal e ; 3' _ 6. US EPA ID Numberr,« <br />•' `t;14±rFrk, <br />. Trans erg y Name .' 8. PA ID um er <br />_ <br />f!, X5.40 <br />01- <br />9. Designated Facility Name and She Address 10. US EPA ID Number <br />p 1 �y (qa• o8hyy'^Y l�rt`9 , �'•' " <br />G,bSoilio N1tic U'GD, <br />Cory Ar(tPLa j4Z- <br />wI <br />101 041 <br />- 12. C to <br />11. US DOT Description D�Winti'Proper Shipping Name, Hazard Class, and ID Number) <br />3. o[ 4. 1. <br />Quantity Unit Waats No. <br />- No. <br />Type WI/Vol <br />a <br />(S a ¢ �11�c k of l /w F+a%r/ <br />� <br />State <br />EPA h r <br />NW,43 <br />/JQ/S9: <br />-,roll / K /7��OM/ <br />I 4019/fz /Q <br />E <br />b.St <br />A <br />EPA/Other <br />T <br />O <br />R <br />C. vg. <br />State <br />- - <br />EPA10ther <br />d, - <br />State <br />- <br />EPA/Other <br />J. Additional Descriptions for,Materlels Listed Above„+K Handling Codas for Wastes Luted Above <br />_. C. d <br />16. Special Handling Instructions and Additional Infbrmelio <br />FEB 21 1989 <br />6. rrvrora..n v- -. <br />GENERATOR'S CERTIFICATION: I hereby declare that ihpFpnlq(rts/qA t�uYYp�mi��t are fully and accurately described above by proper shipping name <br />international <br />and are classified, packed, marked, and labeled, and are idd s8 s 'Tfhn f- ndition for transport by highway according to applicable and <br />national government regulations. i <br />If I am a large quenthy generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined <br />to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the <br />present and future threat to human health and the environment; OR, it I am a small quantity generator. I have made a good faith effort to minimize my waste <br />generation and select the best waste management method that is available to me and that I can afford. <br />Printed/Typed Name <br />Signature Month Day Year <br />T <br />R <br />1 ap rte(`f Ack 9 ent -bl' Redell5f ITT Matena la <br />Af <br />A <br />Prirded/Typed NameSig <br />re Month Day Year <br />N <br />P <br />O <br />. Tran otter 2 n em ei of Materials <br />R <br />T <br />Printed/Typed Name Si Month Day Year <br />E <br />19. Diactepancy Indication Space <br />F <br />A <br />y' <br />C <br />I <br />L <br />1 <br />20. Facilhy Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted In hem 19. <br />T <br />Y <br />Printed/Typed Name <br />Signature Month Day Year <br />DHS 8022 A (1/88) <br />EPA 8700-22 <br />(Rev. 9.88) Previous edition$ are obsolete. <br />Do Not Write Below This Line <br />Blue: GENERATOR SENDS THIS COPY TO DOHS WITHIN 30 DAYS ' <br />To: P.O. Box 400, Smramento, CA 95812-0400 <br />