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fStale of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-99) SCE IDSYEUCYIODS OD i20[i( 0 190 b. Deporlment ofSacra Toxic Substances California Control <br /> Meme print or type. Farm designed for we on @life II 2-pilc :svrirev Sacramento,California <br /> I. Generator'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 4 a of 1 <br /> 3. Generator's Name and Mailing Address A. 5tate Manifest Document Number 21928491 <br /> 'k 1 9 2 8 4 9 1 <br /> AOVANGEED INDIJ91RIM. GOATTNGS L <br /> 0 <br /> tW INDU91 RIM.ESL.Vr). STOCKTON,CA. 95a16 B. Slate Generator's ID <br /> vn 4. Generator's Phone I 20'll 23111-2700 A.U1T: Bft!_Y EXT. 227 <br /> I. n <br /> N 5. Transporter 1 Company Name 6. U5 EPA ID Number Yys� 'e ry yy�� �,+� C. State Transporlar's ID[Rmervd.l <br /> i m r21111T1[)5 E_I'llFiF'[)[IFTIe[/tZ1 Tv'CrMigt!3 y! 0 3 F) 5 � D. Transporter's Phone 6` R 9 <br /> p 41 ��M 377-5747 <br /> m 8. US EPA ID Number E. State Transporter's ID[Reserved] <br /> 7. Transporter 2 Company Name <br /> F. Transporter's Phone <br /> T J <br /> Vi l <br /> G. Stale Facili 's ID <br /> q* 9. Desi nald Facility Name and Sit.Address 10. US EPA ID Number00 Facility', <br /> D K virunnlef dal <br /> Z ��.W U-. X I'll. Sit. H. Facility',Phone <br /> o Vernon, GA xxY 8 9 to 3 3 1 323-26$-•5056 <br /> Q 12. Containers 13. Total 14. Unit <br /> N U 11. U5 DOT Description(including Proper Shipping Name,Hazard Class,and ID NumberI No. Type Ouantiy Wt/Vol I. Waste Number <br /> Z State 181 <br /> tm Non MRA Hpazaryd�ous[WaasteE solid <br /> G { SAND, 1'Altpti� LRIJrVEl6- 171 1 EPA/Other NON-RCR/l <br /> N E state 134 <br /> o N Ml/r1 - RCRA Hazardous Waste Liquid (Dekergent) <br /> 00 00 R ERGO 71 1 / � EPA/Other PTON-RCRP. <br /> c. <br /> V A n Stale <br /> ! o T <br /> 00 O EPA/Other <br /> a R State <br /> F d. <br /> iV EPA/Other <br /> I <br /> W <br /> J. Additional Dauripfio s kr Materials Listed Above K. Handling Codes For Wastes Listed Above <br /> Z <br /> I/N11 a. b. <br /> W <br /> �fbj 355 <br /> � <br /> C. d. <br /> a Za o <br /> Y5. $peps I. gfsdli ti ar glonal Information <br /> Z 24 HR. EMEROENCY CONTAU: 91f3-374'11747 lot; f'roftf, <br /> W 956 ININ EIOT- , STOCKTON, CA-, 95206 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment ore fully andacmrolely described above by proper shipping name and are classified,Pocked, <br /> t Q marked,and labeled,and are in oil respects inproper c°ndition for transport b highway according to a burble international and national ernment regulations. <br /> U Pe P Y 0 `s'OY B PP B°v 9 <br /> j: a If I am large q entity 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 /> practicable and that I av elected the practicable method o treatment,storage,or dispos rr available-tame 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 ort ro ihi my waste generatio d select the best waste management method that is <br /> Oavailable to me and that I can afford. `'s i <br /> 1 } Printed/Typed Name Signaler I Month Day Year <br /> Z f 2 <br /> Z <br /> W 7 17. rens rter 1 Acknowled f Recei 1 of Malarials <br /> t Wy, R <br /> W A Printed/Typed Name ��t),/ � Sign re Month Day. Year <br /> f <br /> j O 0 1 B. Tram rler 2 Acknowled a ent of Recei t of Malarials <br /> R Printed/Typed Name S nabs Month Day Year <br /> T <br /> Q <br /> I N E <br /> R <br /> U 19. Discrepancy Indication Space <br /> Z F <br /> — A <br /> C <br /> I <br /> E <br /> l 20. Facility Owner or Operator Certification of receipt of hazardous motedals covered by this manifest except as noted in Ilam 79. <br /> T Printed/Typed Nome Signature Month Day Year <br /> r <br /> DO NOT WRITE BELOW THIS LINE. <br /> I <br /> DTSC 8022A(1/99) Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 8700-22 To: P.O. Box 400, Sacramento, CA 95812-0400 <br /> i <br />