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Stare of Cabforn" Environmental Protection Agency <br /> form Approved OMB No.--_-_ 39(Ezpires 9-30-991 - See Instructions 00 bOCIC OF DO9p b. Department of Toxic Substances Control <br /> — esgne3/9r use on dib(7Y-pitch) niter. <br /> Sacramento,California <br /> I nerotoes US EPA ID No. Manifest Docume2. Page 1 Information in the shaded areas <br /> I UNIFORM HAZARDOUS ,/ is not required by Federal law. <br /> WASTE MANIFEST249 <br /> " --' of <br /> 3 Oenem or's Namefsn�Malin TT-, ../'�/" A. State Manifest Document Number 72072 <br /> /l>;, 'fJE:: `7' "•> 'P .'/" - W' 8. State Generator's ID <br /> h 4. Generator's Ph... <br /> n <br /> r 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporters ID(Reserved.) -- <br /> h <br /> D. Transporter',Phone <br /> .....:v►/Gy- <br /> o? 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter',Ip(Reserved.) <br /> jF. Transporter's Phone <br /> V 9 Dint naled Facility Nome and S le Address e,,r�! }0. U�EPP Ip,Number G. Stu <br /> Z / - r.✓ �� A'"r ,-. H. Facility's Phone t ! <br /> • Q12. Contoiners 13. Taal 14. Unit <br /> 'V 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. T e Quantity WI/Vol I. Waste Number <br /> Z a. State _ <br /> 3 G { Cf7 ( ,[ / EPA/Oiherlr c- <br /> o N b' fi / stare <br /> co E EPA/Other <br /> v R <br /> IN A <br /> o T State <br /> m O EPA/Other <br /> R <br /> w I <br /> all. Stare <br /> Z <br /> Z <br /> w EPA/Other <br /> V <br /> rn J Additional Descriptions ForMaticrials Listed Above j K. Handling Codes for Wastes Listed Above <br /> W a. <br /> N <br /> W ql <br /> K 2A� vN +suF JS.Yx�y, nr '.. d <br /> uY <br /> 0 15. Special Handling Instructions and Additional Information <br /> Z <br /> F <br /> I& GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper ship ing name and are classified,packed, <br /> Umarked,and labeled,and ata in all respects in proper condition for transport bj highway according to applicable international and nationalrgavernmenl regulations. <br /> f If I am a large quantiy 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 economically <br /> as- practicable and that Minselected the practicable method a treatment,storage,or disposal currently available to me which minimizes the present and future threat to human heap <br /> and the environment;OR,if Iam a ..If quantity generator, I have made a good faith effort to minimize'iny'waste generation and select the best waste management method that is <br /> a' ay.ilgble to me and that I can afford. <br /> O <br /> } Primed%Typed,Nome - SignatureAbnth Day Year <br /> V <br /> W T 17 Transporter 1 Aron wledgement of Receipt of Materials <br /> ac 'A P inbd/Tlyped Name Signature - Month. Day,..., Year <br /> w <br /> f A . ;,4, <br /> .-, <br /> W <br /> 0 78. Trans rter 2 Acknowledgement of Receipt of Materials <br /> O R <br /> T Printed/Typed Name Signature Month Day Year <br /> w C <br /> N E <br /> (aj 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> 20. Facilitin,Owner or One rotor Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> Printed/Typed Name Signature Month Doy Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />