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Stare of Coli(omio--Emironmamvl Protection Agency <br /> Form Approved OMB No.2050.0039(Expires 930-94) SO! In Sfr Vcflang On bOCI( O • b. <br /> Pleose Print 0'type. Form dniprwd for use on efix,(12pM)eKwrUer, �9 06pa Soommerml of o,C.11lo racer Control <br /> UNIFORM HAZARDOUS 1. Gene atols US EPA ID No. Manifest Document No, 2. Page I Information in the shaded a eas <br /> WASTE MANIFESTis not required by Federal law. <br /> CAD 10101 L'51 0�51141-21'21211 3 of <br /> 3. is Name and Mailing Address <br /> N 4. Gener ne OrJ L 9 S 2.0 to <br /> S. Transporter 1 Company Nome 6. UB EPA 10 Number ,.Stote ranaponels ID <br /> b <br /> _ mels Pfaa • '�T <br /> rl 2%1 n1 <br /> Q� 7. Transporter 2 Company Name B. US EPA 0-Number r fD. <br /> V <br /> Z9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> RXMCIS &NVI"4'VTN't5'U. SLRVIM u <br /> 1515 SOU fi RIVfjt ROAD, SVEST SACR.AMESYIC) C,A 95691 Phone <br /> F H. Facih <br /> J r <br /> L 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Taal 14. Unit <br /> No. Type Quad Wf al sue Number' <br /> = a. <br /> NO 2Cea OA7Ae,Dovs WA57r- Uav,47 <br /> v L <br /> O her <br /> E <br /> �» N b. <br /> � E <br /> Aa A her <br /> S a <br /> D <br /> _ t' <br /> Y R <br /> L <br /> Z d, <br /> L <br /> J <br /> L <br /> n <br /> L <br /> n <br /> L <br /> Y <br /> J <br /> Q <br /> 1' 15. Special Handling Instructions and Additional Information <br /> S U,'C APPROPRIATE PROTlx7Z'IVB GBAR, USF, STANUARD ISAFP,"PY RD.6CAUPI017S. <br /> L <br /> c 2%0.YJP f2:Yn'!1CP ; 916-371-5747, 400-456-7745. <br /> J 16. GENERATOR'S CERTIFICATION: I hereby declare that the content of the consignment aro fully and accurately described above by proper shipping name andQ aro classified,pocked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,stale and international laws. <br /> J <br /> ' If I am a large quantity generator, I certify that I have o program in place to reduce the volume and toxicity of worse generated to the degree I hove determined to be <br /> L economically practicable and that I hove selected the practicable method of teelmsnt,storage,or disposal currently available to me which minimizes the present and future <br /> n threat to human heoith and the environment,OR, if I ons a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> y, waste ma emenf mood Mol i,available to me and that I can afford. <br /> Prlmd/Typ(d yome Signature <br /> Month Day Year <br /> L T 17. Transporter I Acknowledgement of Receipt of Materials <br /> U <br /> e <br /> Y N Pri ped Name Sig Merxh Dry Year <br /> e C <br /> laE o 1B. irons user 2 Acknowle a ret o Recei 1 0l Materials <br /> Printed/Typed Name SlgriaNro <br /> Day Year <br /> uI 19. Discrepancy Indication Sp;. <br /> 2 F <br /> J A <br /> L C <br /> LTFacil Avner or 10121 Certification of receipt of hazardous materials covered 6 this monifesl except as nosed In Nem 19. <br /> Printed/Typed Name Slgrature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> )TSC 8022A (7/92) To: P.O. Box 400, Sacramento, CA 95812-0400 <br /> -PA 8700-22 <br />