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//^alllomle �leellh and Wallets Agency <br /> .Iproved OMB No. 2058--0039(Expires 9.30-91) See In tructions an 13aC loage 6 Department of Heenth Service% <br /> �t t 8n{� Front Ot Pa Toxic Substances Contra)Divisior <br /> I print or type. (Form designed for use an%fits( ch typewriferj. SacremeniI Cslifomce <br /> UNIFORM HAZARDOUS 1. Generator's US EPA I No. Manifest 2, page , <br /> f" WASTE MANIFEST O S arum nt o� lnlormetion in the shaded arena <br /> _ O CJ of is not required by Federal la•.. <br /> r 3. Generator's Name and Meiling Address e'r" <br /> ,r.{l "za LC-Es A. State Manifest Document Number <br /> . 89727050 <br /> B State Generator's ID <br /> 4. Generator's Phone <br /> fIj b - ansporter 1 Cory % t}. US EPA ID Nu erPState Tranaparfers ID <br /> rn <br /> ti <br /> N &AnilD. Tranaporte7s Phoria <br /> 7. Tra porter2Compsme 8. U EP !D Numh - ,., .. <br /> Q . E. State Transporter"e ID <br /> co F. Transport@r's Phone <br /> 9. Designated Fscl lty NameV <br /> e Address 10. US EPA ID Number G. State Facility's ID. <br /> -s` �A f`�`' YC <br /> a „� N Facility's"one <br /> Z �rc 1/ 'CS <br /> 11. US DOT Des Shipping 12. Containers 13. Total 14. <br /> �� Description(Including Proper Shl in Name,Hazard Class,and ID Number) Ouanlity Unit :'Y Woftim No. <br /> U No. Type Wt/Vol <br /> S11rIN <br /> E jdct COASTCF, ' * C� EP /ansa <br /> 3 N <br /> E b. <br /> o R Stale . <br /> co A <br /> W T <br /> O EPAICrlher <br /> a R C. <br /> g State <br /> ro . <br /> EPA/other <br /> Er <br /> d State <br /> Z <br /> W <br /> U <br /> EPA/Ottrar <br /> w <br /> Z J. Additional <br /> �y-- Descriptions for MWeriali Listed L� K%Ffandlhlg Codes for Wastes Listed Above <br /> a LZ <br /> V3 -,ra[`If-1C • '7-- 11 t 'Coor <br /> LLJ <br /> l��t/jam r � d d <br /> O <br /> 15. pe,ial Handling Instructions and Additional Information <br /> Z <br /> r <br /> F t <br /> J <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipprng nI <br /> -+ and are classified,packed•marked,and labeled,end are In■ff respects In proper c"ditlon for transport by highway according to spable Interrutional sad <br /> a- national government regulations. pNc <br /> If I em a large quantity generator.I certify that I have a program in Place 10 reduce the volume and toxicity of waste generated to the degree I have delete ned <br /> p to be economiceily practicable and 11191 1 have selected the practicable method of treatment,storage,or disposal currently available to me which mioinI the <br /> y, present and future threat to human health and the orMronment;OR,If I em a small u re or. Intmize my waane <br /> 0 generation and select the beat waste management melhod that is available to nd that <br /> Z <br /> U.] Printed/Type a Si et a Month Elel Year <br /> t7 <br /> w <br /> W T 17. Transporter I AC on dgemeof Receipt of Materials <br /> Z R <br /> A PrinjedlTyped Name <br /> N Sir WORM feet. Year <br /> � 5 <br /> O P <br /> LU O IS Trina orler 2 Acknowledgomen o1 elpt of Materials <br /> U7 <br /> U R Printed/Typed Name <br /> Ion lure - <br /> Z_ <br /> 19 Dis pancy Indication Space <br /> F Z. rjlc.� I4 4t f`f. 1 �ClyrtY 11'> lye � `i3 '/t <br /> A <br /> C <br /> I <br /> L <br /> 1 20.. Facility Owner or Operator Certification of receipt of hazardous motorists coverSo by this manifest except a no d in Nem 19. <br /> T <br /> y Pr/iyf r yped Name Signe Manlh Ov Year <br /> l � � J 1 r Q <br /> OHS8022 A(t ran) <br /> EPA 8700-22 Do Not Write Below This line <br /> EPA <br /> (RE'v.9 e8)Previous editions are obsolete. White: TSDF SENDS THIS COPY TO DOHS WITH' 3Q D <br /> To: P.O. Box 3000, Sacramento, = <br />