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SIS If California--Health and WelfareAgency -V---Sacramento.California <br /> F nprov — <br /> ea OMB No.205G0039(Expires 9-30-91) <br /> pmy7pn. (Forma designed/w use on elite' oech typewriter). <br /> ' Manifest 2. Page 1 Information in the shaded areae <br /> UNIFORM HAZARDOUS ane atore US EPA ID No. <br /> �DggymNriJQo. of is not required by Federal law. <br /> WASTE MANIFEST f ((JJ((ff A. state Manses a MINumber <br /> 3. OanerntO Name and Meiling Atltlless <br /> far y�f!K B. State Generator's ID <br /> fir, ♦N rC� <br /> 4. < <br /> e. US EPA ID Number C: State Transporters ID <br /> inter 1 Company D. Transporter's Phone <br /> v Aao� <br /> N me g, US EPA ID Number E. State TrenapoRar's 10 <br /> b 7. Transporter 2 C Para F. Transponei s Phone <br /> 9 <br /> S 1G. Us EPA ID Number G. State Fecility'e ID <br /> m 9. Deagnatetl Facility Na�me�and <br /> ,.site <br /> (�Address <br /> D<_ <br /> As d bS ? <br /> �O - 12. CoMainere 13. oral 14. I. <br /> Quantity Unit waste No <br /> 11. US DOT Description(Including Proper Shipping Nagle,Hazard Class,and ID Number) No Type Wt/Vol <br /> State <br /> e. rc <br /> _ : o��y /i/USJ j(,? uID IVAlSltl // <br /> Z <br /> EPA/Otherd <br /> q G k FOo/ <br /> w N Slate' <br /> R bAAsi/ /tel/�N � /ArD�I C� 9 EPA/Ct erQ <br /> Y T q C✓� IV/ �. 0;V0 4 (l ' State <br /> e R c. �,/G l.1/ff"i �' L/rL�/1/, EPA/01 <br /> 7 .3 <br /> ger <br /> m Al i i d�/I/ P L It,U 11; UA1 19 i D M t G <br /> .State <br /> 0i r�lyJ1., Ute; � IJ � 1 <br /> W 4 /1 ' K. Handling Codes for Wastes LNted Above <br /> W J.gAdditional scriptloru lot Maieriala Listed Above / ry l y� z 1 a. b. <br /> OZ 44t. t/IGJ4�,f"F//T�'j5 ffV 7 <br /> t �1 / `�fr. slHic`!e t,�u,t?3 rr�lll� J33 U � <br /> F, 15. Spacial Hentllinq Inatr tions entl Adtlitional Information <br /> lell <br /> J <br /> O /8. ro er shi in name - <br /> GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of tole consignment are fully entl accurately described above pl p p pP 9 <br /> J end are clesaified.packed,marked.entl labeled,and are in all respects in proper condition for transport by highway according to applicable inlemetwnal and <br /> S national government regulations. _ a <br /> eye re. <br /> f71 If I em a large quantity generator,I tartly that I have a program In place to reduce the volume and toxicity of safe generated to the degree I he"determined <br /> to be <br /> present economically <br /> tlhrpracticable <br /> to and <br /> that <br /> healthI hays <br /> the selected <br /> envirthe <br /> practicablent; ammethod <br /> small treatmquantily 9aneretM. gor,�havee mads good faith sposal currently hort ort to minle to Me�ze mt y waste eche <br /> V generation and select the beat waste management method that is available to me and that I can afford. <br /> Signature Month Day Yeer <br /> SO/Typed Name - OW <br /> WIX <br /> WT 17. Tranepofter 1 Acknowleduve.—I of Receipt of Materials Mpryh pay YMr <br /> R Sign ure <br /> A, PAnt TYpad N <br /> N <br /> O s <br /> P 18. anapaRer 2 Acknowletlgement of Receipt of Materiels <br /> 0 <br /> 519nature - _ .. . AlOotfh DSY YMI <br /> Printed/Typed Name <br /> U T <br /> E <br /> Z_ <br /> 19. Discrepancy Indication Space <br /> IF <br /> A <br /> C <br /> I <br /> L <br /> I 20. Facilf y Owner or Operator Certaicatiem of receipt of hazardous materials covered by this manifest except as noted in Item t - MonM Dey Yeer <br /> Printed/Typed Name r.- Signature <br /> DHS 8022 A 0/88) "136-Not Write Below This Line <br /> EPA 8700-22 JUN 2 3 1992 <br /> (Rev.9.88)Previous editions are obsolete. YELLOW: GENERATOR RETAINS <br /> ENVIRONMENTA! <br /> PERMIT/`.iEft1%i�,E_` >— <br />