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Lan of California-EnviranmenNl Protection Agency <br />Form AppovedSBMB:Na. 2050-0039 (Expires 9-30-99), <br />Please prin, iFm -Fame dssignsdkr ws toe-61iN{f2piich: ypewrihr„ <br />0 <br />CD aD <br />Cie <br />�V <br />Z <br />3 <br />w <br />Z <br />Z <br />W <br />u <br />Z <br />O <br />z <br />Z <br />O <br />Zz <br />J <br />0 <br />O <br />Z <br />W <br />w <br />0 <br />O <br />W <br />V <br />See Instructions on back of p./ 6. Department of Toxic SAllo.c.s Canal <br />Sacramento, Calif.,;. <br />DO NOT WRITE BELOW THIS LINE._ <br />)TSC 8022A (1/99) White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />EPA 8700-22 To: P.O. Bon 3000, Sacraments, CA 95812 <br />' <br />UNIFORM HAZARDOUS <br />1. Generators US EPA ID N.. <br />Mani6fl Document No. <br />s� <br />2. gaga t <br />In(ermolion in Iba shaded areae <br />is not required by Federal law. <br />WASTE MANIFESTof <br />o O171010 <br />3. Generolor's Name and Mailing pcd ss d ` �c / , <br />4A, "x-` <br />A. Stile Manlfast Document Number 22918156. <br />B. Sbro Generabr's ID <br />4. Democrat', Phone I 1 .Ock (c..,@ C/JY� 9q& <br />S. Transitions, 1 Company Nama 6. US EPA ID Number <br />'C- Stole Trompornr'a ID IR.F•F ^•d.I <br />S,NLL <br />T/ <br />D. Tzampoasn's Phone 40 7 (� <br />7. Tramper r 2 Company Name S. US EPA ID Numbr <br />E. 5bh TronsporNYs ID j ened.I <br />F. Transpxnr's Phone <br />9 Designated Facility Name and 5i /�ddr K 10. US EPA ID Number <br />ilu P.. "lo <br />-G. SIP acil' sJ <br />Jr. 7- (p 's s lrr,re- <br />H. Facility's Phone <br />5:00 9vo 23 7rQ E101 ol <br />313 / <br />.723- Ztof-5b.TYo <br />is <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Cenbinan <br />12. <br />Q Tela) <br />13, Tota <br />14. Unit <br />W. Unit <br />Vol <br />1. Wash Number <br />7Y • <br />a. Ala �Zra,F-..f�4i. <br />sate 3 572— <br />iZD <br />G <br />Not <br />O Z d O <br />P <br />EPA/0X 4- <br />Eb. <br />N <br />sate <br />R <br />EPA/Other <br />A <br />T <br />sen <br />O <br />R <br />EPA/OIFx <br />d. <br />5bn <br />EPA/atx <br />J. Additional Deaaiplip"a far Material, listed Above / - / <br />Q <br />Handling Codes far Wanes <br />Gsled Abwe <br />b. <br />35D50�o'�Ll <br />d. <br />c. <br />15. Spxfal Handling Insadctiam and Additional Informvlion <br />7—V6. Cl?,# S—Aa —ZCi -0/TT/ <br />Sw {tr .9T •Derlcl4 ,I is <br />5 <br />16, GENEMTOR'S CER"I'MCkTIOW I tensity deciate that c nems of this carnig etas fully and accurolel describd obweby propershipping tame and are clussiRd, packed, <br />marked, and labeled, and are in all respas in prop r candieon fes transport try highway according to applicable interactional and nalonui gavermi regulaliom. <br />If I am is I." gvanliry 9 ... rotor, I certify that 1 hero a program in plot. to rdvice the "isms and toxicity of waste generated to the degree I hare determined to be econamically <br />pracficable and that I h .s seNcnd the pronfcable methods! vealmanl, arorage, ar d'npos I <br />and rM aw'vonmmp OR, it I oat s small miry generator, I have made g good faith eicri <br />currxly available to me which minimizes the pre»m and (veto threat b human heabh <br />to minimize my ware generation and select the best waste management method that is <br />available to m. and that I oan afrord. <br />Printed/Typed N <br />0 .tare <br />Month Day Year <br />ep"i <br />o I s' (5 470 <br />T <br />17, ram r 1 Aclinowl meter of Receipt of Materials <br />A <br />Pdnd yped Nome <br />�Ila�/ <br />Si <br />1 ` <br />r <br />Month Day Year <br />s <br />,¢ <br />o <br />R <br />18. Transitions, 2 Acknowld ement of Reni t of Mannola <br />RPrinnd/Typd <br />Name <br />Signature <br />Month pay Year <br />It <br />19. Dismpancy l nd�d�tion Spore <br />c <br />I <br />k <br />) <br />20. aciG ear or Operamor ComfificisfinIisceiptih hazardous material, <br />coversellor it manila) e 1 as n lad in I m I9 <br />T I <br />Ir <br />Matti al Now. <br />Si nm <br />— <br />pbnth Day Year <br />DO NOT WRITE BELOW THIS LINE._ <br />)TSC 8022A (1/99) White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />EPA 8700-22 To: P.O. Bon 3000, Sacraments, CA 95812 <br />