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Seam.f California-Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 930-99) See Instructions on back of atsQ¢ b. Department of Tonle Substances Cont, <br /> Meow print or type. Form designed for use on eNm 112-pitch/r ter. Sacramento,Califemm <br /> Iieft6neromr's US EPA ID No. Manifest Document Nod 2. Page I Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal low <br /> WASTE MANIFEST I I I I I I I I I I I I I I I Iof <br /> 3. Generator's Nome and Mailing Address A- State Manifest Document Number ,e ,Z <br /> y4M AV AM, I) 4NIA;, 41 i!" i.(s/h 1 4`4t r', •,b�wx <br /> O "I 9"011)'i IFFM CAVO- sp I tLel,'.IK.I CIFO. 1..A .,Li.ti,110; B. Stam Generator's ID <br /> run d. Ge..tartaric Rlrrm I «eLL'1 r!:il,-;7/Safi .sSk!7T: !,fl 1 <br /> C4 5. Tramportr 1 Camporry Nrsnm 6. US EPA ID Number C. State Transporter's ID(Reserved.] <br /> r <br /> m limnsr,.•� ss,ver•ss„cr^es A 1 1 1 1 D. Tra ,paHer's Phone <br /> O <br /> m 7. Transporter 2 Company Nome 8. US EPA ID Number E. State Tmmpormr'z ID(Re=rvedrued.] <br /> 1. Tronsporter's Phone <br /> Q <br /> V 9. Designated Facility Name and Site tsAdfd.o 70. US EPA ID Number G. Siam Facility's ID <br /> Q <br /> Z e i£ri <br /> •�. s H. Facility's Phone <br /> p AfNk*9FY" , CA '�111[i.73 � y erre <br /> LL <br /> 11. US DOT Descriptio^(including Proper Shipping Name,Hazard Class,and ID Number) 12. Conroinen 13. Tobi ld_ Unit <br /> EJNo. Type 0..lit, Wt/Vol I. Waste Number <br /> Z o.� { Stas. <br /> 3 G I..f�Ci �(pF.l I_71,i EPA/Other <br /> E o <br /> N 6. State <br /> m E <br /> < R EPA/Other <br /> v A <br /> o T c Stam <br /> m O <br /> R EPA/Other <br /> ac <br /> t- d. Srote <br /> Z <br /> w <br /> V EPA/Other <br /> r 1. Addilipml Description,for Material.Listed Above K. Hanni Cade,for We,%,Listed Above <br /> Z a b. <br /> N <br /> w <br /> a <br /> C. d. <br /> Z 15. Special Handling mstrunbns and Additional information <br /> O <br /> Z <br /> S <br /> s- <br /> I6. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment ore fully and accuraM described above by proper shipying name and are classified,Accord, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applien cable inter cnio^al and national government regulations. <br /> IF I am a longe quwny generator, certify that 1 have a program in place ro reduce the volume and toxicity of waste generated b the degree I hove determined to be economically <br /> N practicable and that I haw selected 16. racticable method of treatment,acroge,or disporal currently available to me which minimizes the present and future threat b human lumix <br /> and he environment:OR,J I am a small quantity geaerotoq I have made a good Faith eF6rt te minimi any wsN Riemannian and.lett the best worm management method that is <br /> voil.ble to me and that I can afford. <br /> O <br /> )_ P- ted/TYped Name 111 i s- a#6 - i Month Day Year <br /> L j T 17_ Ticinworlew,I Ac ”t of Receipt of Malriab <br /> w 1 Pri^ted/Typed Nyml 9lgnalun MonRs DAY Yetis <br /> R 18, Lan 2 Acknowledgement nt of Receipt of Mutarials <br /> O T Primed/Typed Name Signature Monde Day Year <br /> w [ <br /> Q 1 <br /> V 19. Discreponq Indication Space <br /> Z P <br /> _ A <br /> C <br /> I <br /> L <br /> 120, F.vhtt,Owner of Opterashor Cern tikahaof receipts of hazardous materials covered by this manifest stroseept as noted in Item 19. <br /> T Printed/Typed Name Signature re MDay, Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/99) <br /> EPA 8700-22 xaiia..- GENER.:'.Ok REIA.i1,1 <br />