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State of California—Envirodimental ProtecfiooAgency <br /> Form Approved OMB No,'2050-0039(Expires 9-30-99] See Instructions on back O� a 6. <br /> ( 9 Department of Toxic Substances California Confn <br /> Please print or type. Form designed for use on elite(72-pitch rifer. Sacramento,California <br /> 1 <br /> (' UNIFORM HAZARDOUS .. 1. Generator's US EPA:ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> s not required by Federal law. <br /> WASTE MANIFEST �y © (af/ <br /> It,6. enerator's Name and Mailing Addreys f2�DDu1Ay A. Stale Manifest Dodument Number <br /> \. 3233 LAOMts ll 2,9771073 <br /> O - <br /> =CV--w r C& B. Slate Generator's ID <br /> h � <br /> 4. Generator's Phone' <br /> NW_, 1 <br /> 5. Transporter 1 Company Name _ss+' 6. US EPA ID Number C. State Transporter's ID(Reserved.] <br /> Ou q �V 4 /1 D. Transporter's Phone( oq <br /> y GJ `IKCJF'Z '" <br /> LO Q- <br /> 7. Tmnspor Y 2 Co any Name 8. US EPA ID Number E. State Transporter's ID[Reserved.) <br /> F. Transporter's Phone <br /> Fycif Name and Site Addrer ss 10. US EPA ID Number G. State Facility's ID <br /> �--Iz i103(0�W� 1li-h S'+-- <br /> O H. Facility's Phone <br /> I"—!J: 1,0" CA 94081 2-432-5`f'i �- <br /> Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number 12. Containers 13. Total 14. Unit <br /> o V P I' 9 P PPS^8 ) No. Type Quantity Wt/Vol I. Waste Number <br /> CVZ aV/A'TE P&IN! hy TRELb TGD Md-TMIdL, State��! <br /> -',...3 G 3 N1 r rV1 Y 6 >I/L 1 I a 17 1y EPA her 1 <br /> E <br /> ce � b. P&kIoo JT- ct- TED ML>T�-21esL , state00 <br /> 'V R 3 ' ..t I el'Y V 1 1 1� /�00 <br /> EPA/sO�k, <br /> v A v `4N'iM'• V D O S7 3Ja©0 <br /> O T c. <br /> State <br /> ro O <br /> R EPA-/Other <br /> Y <br /> d. State <br /> 'V EPA/Other <br /> w <br /> h <br /> J. Ad tional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> 0 <br /> UO !I S) Pna t,1T V.rr DEBidlS FRDINA Sp]l-L , tt- -2 o 43 <br /> a. . <br /> Q15. Special Handling Instructions and Additional Information 24 N12 t7 Gt,,,NC <br /> Ill - <br /> Blt-L.. TO ri <br /> 16. GENERATOR'S CERTIFICATION: I herebydeclare that the contents of this consignment are fully and accurate)y described above by proper shipping name and are classified,packed, <br /> Umarked,and labeled,and era in all raspe sin roper condition for transport 6y highway according to applicable international and national government regulations. <br /> J If I am a large quant a ra r,I rti that I have a proggram in plata to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> wpracticabt8 and th a set cted a editable method of treatment,storage,.or disposal currently available to me which minimizes the present and future threat to human health <br /> and the environ f if am: quantity generator,I have made a good faith effort to minimize my waste ner ion and select the best waste management method that is <br /> W available tom t t l c a <br /> } Printed/Typed Signature Month Day Year <br /> w T <br /> (� R 17. Trans rter m <br /> a eeA of Recei t of mete'als <br /> w R Printed/T ped NA gnature Month Day Year <br /> N <br /> w. P. _... . .CS - - 6__ <br /> LL p 18. Trans orler 2 ckn led a ent of Recei t of Mmerials <br /> R Printed/T ed Name Si na e <br /> W T YP 9 Month Day Year <br /> w E <br /> Q R <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> _ A <br /> C <br /> 1 <br /> L <br /> t 20. Facili Owner or Operator Certification of recei f of hazardous materials covered b this manifest exce t as noted in Item 19. <br /> 'Y Printed/Typed Name Signature Month -Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A 11/99] Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 8700-22 To: P.O. Box 400, Sacramento,.CA 95812-0400 <br />