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State of California-Environmental Protection Agency See Instructions on back c' ge 6. Department of Toxic Subslocas Central <br /> Foray Approved OMB No.2050-0039(Expires.9-30-99) Sacramento,California <br /> Plein*print or type. Farm designed far use-'1 elite(12 pllc writer. <br /> I. Genem[or's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal low. <br /> WASTE MANIFEST ,ry q tp ,} Ti l'g F of <br /> 3. Generator's Name and Mailing Address a A. Stale Manifest Docemant Number 21928490 1 9 2 8 4 9 1/�+V <br /> i dU)YAMl,:s=U tF1E.3U£STRI>l1.1. G:i">1Ka7Nli& L <br /> o sww INL)tJ:;ra w. yIiyLy_YI). sr OC.JK Tarr,c..A 9'Y206B. State Generator's ID <br /> i h 4. Generator's Phone I £_\er it x..atl-.��]{.){) .Rear': faJF I..Y J'.ICT, 'Y.,FI <br /> n <br /> tV S. Tronspoher 1 Company Name 6. US EPA ID Number C. $tole Transporter's ID[Reserved.[ <br /> mD. Tronsperters Phone <br /> oo f2a/1'11.15 r'.'fiV11-S/ITMF}Pr1I:'Br -iegViews 1; .. - 5}' { �P �`a t"} 916 ;371-.'5747 <br /> CP 7. Tramp.rh r 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Res x-v.d.I <br /> ! Q F. iransporler's Phone <br /> f V 9. Designated Facility Name and Site Address 10. US EPA ID Number G. Stale Facilites ID <br /> �00 4 P-acifte Iiwiv uk 4w Peew wel p' <br /> IN 2 11100. H. Facility's Phone <br /> I) o L.r_>->nlau�lt=5, CA !XRVr :Pa �' t .?' a 9 a ski{?- X19-7145 <br /> LL <br /> T— !E <br /> 12. Containers 13, Tocol 14. Unit <br /> N 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity WI/Vol I. Waste Number <br /> i Z a. Stale .343212 <br /> t= W■anto P(�R(aqint Rolal.od m a{f:Iial'.3. 4ffVi 6+-1s 111 EPA/Other <br /> E05 Stale DON <br /> o N b. <br /> m E EPA/Other <br /> v R <br /> A slow <br /> C. <br /> o T <br /> O EPA/Other <br /> R <br /> w d. Sale <br /> wz <br /> EPA/Other <br /> V <br /> w <br /> im J. Additional Description�s/Far Material,Listed Above K.�H..dlinq far Wastes Listed Above <br /> N <br /> ts- 19 <br /> W <br /> s c, d. <br /> f z sp7oH�pa zir7'3o¢ q <br /> O I-jA.,7fjf' F"',dlspp.ln}.1{19chlis>Vd,9Q:a'f4anal information <br /> Z 2.—I t-IR. LMLf1GL-f4S r ( GI1PlVeV a 9111 �+ ! ,'1 1.11, �'rraflle ` <br /> = B5!a1Nr?LIS.?i?IA,I £ails, `iT �\�:Kri?N, CA, t)5s(10 'f0^Otg1 <br /> F <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consig ntare fulFjand accurately described above by proper shipping name and are classified,packed, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> 4 If 1 am a large q ontiy generator,I certify that I have a pro gg m in place to reduce the volume and toxicity of waste generated to the degree I have determined ro be economical)y <br /> n. pr ticable and that I ma selected the practicable methodaytreatment,storage, disyasuYmprre tly available to me wh*,h 9� ze the present and future threat to human health <br /> N and the environment;OR,if a moll gaanfity generator,I have mode a good F i1K efForf Id,mint ize my waste <br /> 7 eration do d select the best waste management method that is <br /> available to me and that I can afford. y <br /> O <br /> ` } Printed/Typed Name Sign re 7 I Month <br /> Do y Year <br /> t V ^ TSI s7 <br /> WT I Tr ns rtur 1 Acknowe ement o Recei t o Materials l <br /> oc A Printed/Typed Name Signature Month Da� Year <br /> oc // ,5./_ <br /> I 0 18. Tnm,t3ort.r 2cAeknawled em mt of Recei t of Maleriala <br /> RPrinted/Typed Name Signature Month Day Year <br /> l Q p <br /> l V 19. Discrepancy Indication Space <br /> A <br /> C <br /> L <br /> 20. Facility Owner or Operator Certification of receipt of ha=ordain materials covered b Ihn a anlfest except as noted in Item 79. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> i DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A 11/991 Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 8700-22 To: P.O. Box 400, Sacramento, CA 95812-0400 <br />