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N <br />h <br />m <br />g <br />m <br />00J <br />�a <br />LU <br />ti= <br />WO <br />N� <br />00U <br />2 <br />DHS 8022 A (I/88) Do Not Write Below This Line glue: GENERATOR SENDS THIS COPY TO DOHS WITHIN X - <br />EPA 8700-22 <br />(Rev. 9 -se) Prwlous editions are obsolete. Tv To: P.O. Box 400, Socromeoto, CA 95812-0500 <br />rF'r"n <br />I. Generatoi s US EPA ID No. Mondrian <br />UNIFORM HAZARDOUS <br />2. Pepe 1 <br />Information M the shaded areas <br />WASTE MANIFEST ocliment <br />o <br />of <br />is not required by Federal law. <br />3. Ganwstw's Ng�o� a and Meiling Addrasl�— <br />j1�uk-/ I/dCMoN/► l 7+V rz/. <br />A. Stats Wmles1 Docwnent NwnMr <br />3SDO hj -f '/, Al C'q.., <br />8. State Genwatoes W <br />4. Gwierstor's Intone ) 3S /y/ <br />i?iP-Zi3i1i7Ld171Zr1 i 1 <br />8. Tritnaportw 1 Company Name e. US EPA ID Number <br />C. State Tranapartei• 10 <br />Transporter Phone - <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporters ID <br />F. Tiensporteis Phone <br />�led F Not, I O NaS dam,°A,q 1,� Q �-NG US EPA ID Number <br />D)Iz <br />G. Sate Focally 4 D <br />Nd 4 h m /! It Q (c� <br />K Faciety's Phone <br />CA- 23309 iCiAlDf?A I 71 <br />(./13 <br />12. Containers <br />13. Total <br />la. <br />I. <br />11. US DOT Description (Including Proper Shipping Name, Hazard Claes, and ID Number) <br />Quantity <br />Unit <br />, Waste No. <br />No. Type <br />Wt/Vol <br />a. <br />State <br />QoUs <br />E <br />N <br />O <br />EPA/ goer <br />E <br />It. <br />State <br />R <br />A <br />T <br />EPA/Other <br />O <br />R <br />C. <br />Slate <br />EPA / Other <br />tl <br />State <br />IN <br />EPAIOu»r <br />J. Additional Descriptions for Materiels Listed Above <br />K Handling Codas list Wastes <br />Luted Above <br />o- / �- �,. <br />a. <br />b. <br />O,,�V4d- li Afa-a FEB 211989 <br />C. <br />d. <br />ENTAL H"eALTH <br />5. Special Handling Instructions and Additional Information P <br />(o& -RR �rOTE'c tt'✓c' QL47Tb-i2 WtA'e 6f8so)^j —d1 <br />18. <br />GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are July and accurately described above by proper shipping name <br />and are classified, packed. marked. and labeled. and are in all respects in proper condition for transport by highway according to applicable international and <br />national government regulations. <br />If I am a large quantity generator. I certify that I have s 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, if I am a small quantity generator, I have made • good laith 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 Deli Yea, <br />ti <br />T <br />R <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />A <br />"s <br />Printed/Typed NameSipnat <br />/ Month Day Yea, <br />C 4 /I <br />P <br />O <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />RPrimed/Typed <br />T <br />Name <br />Signature Monro DaY Yeo <br />E <br />1 I <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />1 <br />20. Facility Owner or Operator CeniBution of receipt of hazardous materials covered by this man9an except as noted in beth 19. <br />TSi <br />Y <br />Printed/ Typed Name <br />g natwe Month Day Year <br />DHS 8022 A (I/88) Do Not Write Below This Line glue: GENERATOR SENDS THIS COPY TO DOHS WITHIN X - <br />EPA 8700-22 <br />(Rev. 9 -se) Prwlous editions are obsolete. Tv To: P.O. Box 400, Socromeoto, CA 95812-0500 <br />rF'r"n <br />