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Form Approved OMB No.2050-0039(Expires 9-3088) rv: Toxic Substances Control Chile. <br /> Please print or type. Form designed for use c^nlfle(12-pitch typewriter). Sacramento,Celitoi <br /> UNIFORM HAZARDOle., I1. Generator's US EPA ID No. a o P formation in the shaded areas <br /> WASTE MANIFEST of a not required by Federal law. <br /> 3. Generator's Name and Mailing Address FEB 4 anifeat Document Number <br /> o�leF,r, Ac, till r 1 0fl5 <br /> Nf ;<t- M ENVIRONME AVI c for's ID <br /> e. Generator's Phone ) PERMIT E <br /> 0 5. Tr nsporter 1 Company Name Er. US EPA ID Number C. tate ranaporter's 10 <br /> to D. Transporter's Phon <br /> N <br /> 1 m 7. Trenspo er 2 C mpany Name 8. 1'4 EPA ID um er E. State Trenaporter'e I <br /> 8to F. Transporter'a Phon <br /> 9. Deaiflnetetl eeil8y Neme ono Site Addreaa US EPA ID Nu a G. State Facility'&ID <br /> UC ME,enU w .,,ao n e[Cc& A lU n)E�,1 <br /> U % H. acility' n, <br /> 2 <br /> 12. Conteinera 13. T64111 14. I. <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class.and ID Number) Quantity Unit Waste No. <br /> No. I Typo Wt/Va <br /> ZG a. cG Wds4 (/;I r..�`flVa•S�/�(-:. State <br /> F E EP Of er <br /> ` E N <br /> P E State <br /> N R <br /> to W A EPA/Other <br /> r T <br /> e R C. State <br /> 0 <br /> 0 <br /> m <br /> „ EPA/Other <br /> W d. State <br /> i <br /> (Wj EPA/Other <br /> W <br /> l O J. Additional Descriptions for Materials Listed Above 5 K. Handling Codes for Wastes Listed Above <br /> b. <br /> ¢ d. <br /> 1r - <br /> a <br /> Z <br /> o <br /> 15. Special Handling Instructions and Additional Information <br /> 2 <br /> S <br /> H <br /> J <br /> J <br /> O 18. <br /> IF GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping <br /> i name and are classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable <br /> F international and national government regulations. <br /> f m If 1 am a large quantity generator, 1 certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have <br /> determined to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to <br /> me which minimizes the present and future threat to human health and the environment; OR, if I am a small quantity generator, I have made a good <br /> V faith effort to minimize my waste generation and select the best waste management method that is available to me and that 1 can afford. <br /> 2 <br /> W Primed yped Name Signature // Month Day Year <br /> W <br /> W 2 <br /> R 17. a porter 1 Acknowledgernerd of Receipt of Materials <br /> < A Printed/Typed ams Signature Month Day Year <br /> N 1, <br /> u. S <br /> O P <br /> W O 18. Tilliffilipbrfor 2 Acknowledgemen of Receipt of Materials <br /> OT Prints /Typed Name Signature / Month Day Year <br /> E <br /> i . ice- v js <br /> 19. iscrepancy Inpication Sp e / <br /> A <br /> C <br /> t L <br /> ` I 20. Facility Owner or Operator Certification of receipt of hazardous materiels covered by this manifest except as noted in Mem 19. <br /> ( T <br /> V Printed/Typed Name Signature Month Day Year <br /> `[S[ <br /> DHS 8022 A(1/87) INSTRUCTIONS ON THE BACK <br /> EPA 8700-22 YELLOW: GENERATOR RETAINS <br /> 4p (Rev.9-88) Previous editions are obsolete. <br /> tp1 <br />