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Please int or I e. Form tlan nail for use do eltls dc^1 sewnfer Sacramento, California <br /> ..� UNIFORM HAZARDOUS ^•Utarot a Us EPA ID � a, 2, Pao! , <br /> WASTE MANIFEST 14 1 ;Q Olr� / is not requiationred <br /> a Ilia shaded areas <br /> °f is not required by Federal law. <br /> Generator's am and MAAing Address <br /> r r[ rt ��v r J� �F✓ I, ' / �� ^ /� 1 �} A. Slate Menrinsl Document Number <br /> � G' / f 81434885 <br /> \ ; i,Qf//rr /v ?A' �j7 0'✓Z 7 j B. Stasi Gana.Cot's ID <br /> AN419a. "anerator's Phone(o,I`+I �r `, <br /> 5 r: spm nr 1 ny Namn 6. _ <br /> US EPA ID Number C. Stele Tranaportnr'a 1 <br /> Z)iTrenap°rterl Ph _ <br /> r. I ] transporter 2 Company Name e. US EPA ID Number E. State Transpon9r's 10 <br /> s <br /> r F Transportar's Phone <br /> '\ = i 9. Ue gn a F I1p/..%aryv ono jn A/aye�y a/.)� ^� -�10, US EPA u)Nu7my{p,�r� ) G. Stare Facility's ID <br /> /•�� <br /> aa— <br /> )L �2q.i/�iSca, H. Facility's Phone <br /> 1 <br /> I <br /> 12. Containers I 13. Total la. I. <br /> Iy ! 11. US DOT Description(Including Proper Stappmg Name,Hazard Class,and ID Number) ClientI Unit Wase No. <br /> Q i No. Type WI,Vo <br /> _ i9 Soli %�N,e G�/ 4.5'TE _ I SI.I. <br /> Z G .�5 I <br /> E IEP Other <br /> 3 i R state <br /> A <br /> Z T <br /> EPA/Other <br /> O <br /> I R °' i slate <br /> C I <br /> EPA/Other <br /> d i Stale <br /> Zi <br /> '- EPA,Other <br /> au <br /> Z J Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> in U�!%z/Gil�'XO U/UJ, V Tr`J.�e. � tiA' ZvI77'� <br /> A. b. <br /> S E'SS TA19fIJ j'dl� t��5/1f!-SAL L✓ QU/A C. d. <br /> ')f <br /> 15. Speciar Handling Instructions and Additional Information <br /> Z) <br /> 16. <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping <br /> name and are classified. packed, marked, and labeled. and are In all respects in proper condition for transport by highway according to applicable <br /> international and national government regulations. <br /> u) If 1 am a largo quanlny generator, I cerbty that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have <br /> G I determined to be economically practicable and that ) 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 goad <br /> faith effort to minimize my waste generation and select the best waste management method that is available to me and that I can all d. <br /> Z <br /> w prmte4,Typad Nama Signature Monty Day Year_ <br /> /�99 <br /> JJ I 4 U /(i'Z� <br /> 17 Transporter I Atknowledgement of Rec ipt of Materials <br /> R <br /> ?i .a Printed Typed Name <br /> N Signatu month Day Year <br /> LL' P <br /> O 18. Transporter 2 Acknowledgement of Reeerpi of Metenafa <br /> 0IRPrimed/TYped Name <br /> Month Day Year <br /> g <br /> E <br /> 2 <br /> 19. Discrepancy lndicabon Spaca <br /> F <br /> A <br /> C <br /> I 120, Facility Owner or Operator gartificabon of receipt of hazardous materials covered by this manifeel te Ig. <br /> TPrints Name Signature <br /> y Month Day Year <br /> DHS 6022 A(1,87) While: TSDF SEN HIS COPY TO DOHS IN 0 DAYS INSTRUCTIONS ON THE BACK <br /> EPA 69.86) To: P , Box jOW, Swomento, CA 95812 <br /> (Rai.9066) Prnaom nJdlooa am�baolern. <br />