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State of California—Environmental Protection Agency <br /> t Form Apnrq 1 OMB No.2050-0039(Expires 9-30.99) See Instructions on back Of page 6. Department of Toxic Substances Central <br /> Please pi.,;t or type. Form designed for use on elite 112-plrchl iter Idk 5,93010 Sacramento,California <br /> - <br /> UNIFORM HAZARDOUS orators US EPA ID No. Manifest Document 2. Page 1 Information in the shaded areas <br /> is not required by Federal low. <br /> WASTE MANIFEST f` i. f P f y 1 i of 1. <br /> 3. Genef ee Maung Andress A. State Manifest Document Number s <br /> 101.✓r3 Tl&/J,';'LT7TAh DRrVE <br /> h SrIY7C.WMI? CA 952.+ 6 (209)983-8298 <br /> s. stale Generator's ID <br /> us A. Generators Phone f 1 <br /> N sds Zr IT- .d et"' -SJ s3 Gt =&%4jj J. 6. US EPA ID Number C. State Transporter's ID Reserve. <br /> h <br /> s81.r iQ.�i .3. ('. }t. I. 4'1 .'rJ 7 c} D. Transporter's Phone <br /> O 11 <br /> 7. Transporter 2 Company Name B. US EPA ID Number E. State Transporter's ID Reserved] <br /> V F. Transporters Phone T <br /> U 9 esi n.Ad Facili Nam it.Address 10. US EPA ID Number G. Stale Facility's ID <br /> na iPsi .erit y <br /> 02 'V95 Newlinndz Dr. East <br /> y H. Facility's Phone <br /> O Fernley, P1 89408 (775) 57.5-2760 <br /> V 11 US DOT Description(including Proper Shi m Name,Hazard Class,and ID Number 12. C. !mar 13. Tafel Id. Unit <br /> V V P f' RShipping 1 No. T Quantity Wt/Vol 'I. Waste Number <br /> X a10R-PCRAp RMARDl0115 VAST9 LIQ(111! stale 135 <br /> H T r <br /> 3 G �y ; EPA/Other r <br /> o N b. state <br /> m E <br /> R EPA/Other, <br /> v A state <br /> o T <br /> m O <br /> R EPA[Oflmr <br /> W d. Slate <br /> Z <br /> W <br /> U EPA/Other <br /> W <br /> 1. Ad a i lion n 1 sl 7 K. HandlingCodes For Wastes Listed Above <br /> Z $I � 9$°� p a4�A°� SLB f .. RdTBII7 11) a b <br /> 0 <br /> H <br /> W <br /> °r a. a. <br /> a <br /> Z 15. Special Handling Instructions and Additional Information cau (190) <br /> RSAR PRONM PROTFCTII'F CLOTEIiNG. PERGOCT RESPONSE PRORS (80@j 567-1455- <br /> Z <br /> W <br /> r <br /> 16. GENERATOR'S <br /> m <br /> CERTIFICATION: I hereby declare that the contents of this consignent are fully and accurately described above bypropership ingnameandareclassified,packed, <br /> t4J marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and nalionaPgovernment regulations. <br /> If I am a large quantity generator,I cenify that I have a proggram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> a- practicable and that I=selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future thrmu ns human health <br /> and the environment;OR,if I am a small quantity generator,I hove made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> cd available to me and that I can afford. <br /> O <br /> > P innd/Typed Name Signature / Month Day Year <br /> W ; <br /> U T 17. Transporter I Acknawlodgement of Receipt of Materials <br /> R <br /> wA Primml/Typed Name Signature -i' Month Day Year <br /> w "s 1'P'j 44? 7 r y._ t a.__ GI `J 1a' € % <br /> LL 0 18. Trom.porhor 2 Acknowled amen of Recei 1 of Materials <br /> O RT Printed/Typed Name Signature Month Day Year <br /> W E <br /> Q R <br /> U 79. DiscrepancyIndication Space <br /> Z P <br /> _ p <br /> C <br /> I <br /> L <br /> I 20. Facili Owner or Operator Certification of recei t of hazardous materials covered this manifest except as noted in Item 19. <br /> T Prinled/Typed Nome Signal.. Monlis Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> DTSC 8022A 11/991 To: P.O. Box 400, Sacramento, CA 95812.0400 <br /> EPA 8700-22 <br />