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5rate of XForig
<br /> m I Protection Agency
<br /> Form Ap39(Expires 9-30-991 _- SEC Instructions 00 back O PO9C DepartmSacraent of Toxics California Control
<br /> Plcese paigaed for use on elite f12-pitch)F' -iter. Savamenlo,CaliforniaIn OM s US EPA D No. ManifestDocument Na!✓ 2. Poge I Information in the shaded areas
<br /> RM HAZARDOUS is not required by Federal law.
<br /> STE MANIFEST y2 (r j) @ "t 6 # ( S 9 9 ' 4 ofneurName and Mailing Address A. StateManifestDocv lNumbertts j'!Eci:. ,''i
<br /> 3.800 N. Catirolft" 3tr"!L B. S+ate.Generalorz ID
<br /> 9521
<br /> sn S'>enerob�,lshons( 209A43'-2'50(1 Rt tfst .':+l.a[•a,y , ar,qO 6jssc
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<br /> N S. Transporter 1 Company Name u..e., 6. US EPA ID Number C State Tranxporter's ID[Reserved.]
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<br /> 90
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<br /> {m 7-Tronsporter 2 Company Name 8. US EPA ID Number E. State T ansparter's ID[Reserved.]
<br /> I-� F. Transporter's Phone
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<br /> IU 9. Designated Facility Name and Site Address 70. U8 EPA ID Number G. State Facilites ID
<br /> 1Z 11::':: Wh.a t'.e>. Rovir Road H. Facility's Phone
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<br /> is U 12. Containers fatal IA. Unit
<br /> 11. US DOT Description(including Proper ShippingName,Hazard Class,and ID Numberl NoQuantity
<br /> Wt/Vol I. Waste Number
<br /> Z Slate
<br /> F WANT 0 '7.S.ne: }?OW(jer, 4—:1( Y.2) , U15111436, 11 '.t
<br /> x ' EPA/Other
<br /> 3 G 60101olS
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<br /> mO fea to Liquid:. arldic', -rgAYui r-, "il
<br /> R J•5 x,y+.,, J+ iJFj:t:; bei s t.[ h EPA/Other
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<br /> J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes listed Above
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<br /> 16. GENERATOR'S CERTIFICATION: 1 ereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and ore classified,packed,
<br /> a marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations.
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<br /> If I mn large quantiq generator,I certify that 1 have o p oggr m in place to reduce the volume and toxicity f waste generated to the degree 1 have determined to be economically
<br /> d practicable and that I hove selected the practicable methods treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health
<br /> and the environment;OR, if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is
<br /> available to me and that I can afford.
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<br /> T Printed Typed Noma _, Sig ature Month Day Year^.
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<br /> m T 17. Transporter 1 Acknowledgement of Receipt of Materials
<br /> d' j Printed/Typed Name - Signature Month Doy Year
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<br /> R 18. Transporter 2 Acknowled a t f R iu t of Materials
<br /> O Ri Printed/Typed Name Signature Month Day Year
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<br /> U19. Discrepancy Indication Space
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<br /> 20. Focilitr Owner or Operator certification of receipt of hazardous materials covered b this manifest except as noted in Item 19. _
<br /> T Printed/Typed Name Signature Month Day Year
<br /> DO NOT WRITE BELOW THIS LINE.
<br /> DTSC 8022A(1/99) Yellow: GENERATOR RETAINS
<br /> EPA 8700--22
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