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of Calif -- <br />omi•Emiromessmd Prosection Agency <br />Approved OMB No. 2050-0039 (Expires 9-3096) See Instructions On back of page 6 Department of Toxic Substances Central <br />or type. Form designed for use en .lire 112-,"l e,....,.:r.. ,r AL <br />8022A (9/94) <br />700-22 <br />uU NOT WRITE BELOW THIS LINE. <br />Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />To: P.O. Box 400, Sacramento, CA 95812-0400 <br />1 <br />M <br />AWNS <br />n <br />UNIFORM HAZARDOUS <br />1. CzeneramErM EPA ID No. Manifest Document No. Page 1 <br />omenta, a norma <br />Information in the shaded areas <br />WASTE MANIFEST©g% <br />^7 O Q <br />u G V <br />.y A <br />G 7 of <br />is not required by Federal law. <br />3. Generators Name and Mailing Address <br />Pf4crr-ic. 1364E <br />A. Stole Manifest Document Number <br />95377292 <br />-2(1100 city L/o �o A 2 Ig 1,5`0 <br />B. State 13enerabi s ID <br />4. G•^• w° r pip^• s,e� <br />S. Transporter 1 Company Name 6. US EPA IDN ber <br />C. State Transponer's ID <br />V2& <br />RADIOS ENVIRONMENTAL SERVICES ICIAID10 1414101013151516 <br />D. Transport°"Pho^e (916) 371-5747 <br />7. Transporter 2 Company Name .. 8. US EPA ID Number <br />E. State Tronsporter's ID <br />F.'Transporter's. Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />RADIOS ENVIROMMNTAL SERVICES <br />1515 SOUTH RIVER ROAD, WEST SACRAMENTO, CA 95691 <br />H. Facility's Phone <br />71-5747 <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Co <br />No. <br />I. Waste Number <br />a <br />%%� / /�yys-�— /(� �7 !� ^ <br />/`ice . r � s " 0 � IC. c /� A.State <br />2-2— -- <br />"/`��,���—i <br />• ^I <br />WIW4 <br />EPA/Ot�. <br />N <br />E <br />Is. <br />Stare <br />Q <br />A <br />EPA/Other <br />T <br />O <br />` <br />Star <br />E <br />FPA/Other <br />d' <br />State <br />EPA/Other <br />J. Additio of Descriptions (or Materials Listed Above - .. .. ..._. <br />K. Handling Codes for Wastes Listed Above <br />a. b. <br />0 <br />rY/ 7 <br />iDir 41/9, <br />d. <br />15. Special Handling Instructions and Additional Information <br />pAc i3Lrc.C. <br />HANDLERS BE 40 HOUR OSHA/SARA MATNED <br />AND USE NIOSH APPROVED PPE. /z CS <br />16 371-5747 <br />S TO 70117 /,47 <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described abo4 by proper shipping name and arc classified, <br />packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br />If I am a large quantity 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 to be <br />economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to <br />threat to human health and the environment; OR, if I am a small quantity generator, I have made <br />me which minimizes the present and future <br />a good faith effort to minimize my waste generation and select the best <br />waste mares ennent method that is available to me and that I can afford. <br />ed ped Name SignaNra <br />Day ar <br />r17. <br />OMonth <br />I Z1 <br />I <br />Trans rter 1 Acknowled ament of Recei t of Materkls��Jed/Typed <br />Name dam/^ Sign re <br />Month Day Year <br />F5' <br />0. <br />18. Transporter 2 Acknowkd armor of Recei 1 of Manor Is <br />I <br />Printed/Typed Name <br />Si re <br />Month Day Year <br />R <br />—Space <br />19. Discrepancy Indication <br />F <br />R <br />20. roomy Owner or gorwar Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br />i <br />Printed/Typed Name Signature <br />Month Day Year <br />8022A (9/94) <br />700-22 <br />uU NOT WRITE BELOW THIS LINE. <br />Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />To: P.O. Box 400, Sacramento, CA 95812-0400 <br />1 <br />M <br />AWNS <br />n <br />