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O <br />c <br />-Orm Approved UMH NO. 2U50--0039 (txpnea 9-30-9 1) <br />11 Division <br />DHS 8022 A(7/88) -... <br />EPA 8700-22 <br />;(Rev. 9.88) Previous editions are obsolete. <br />Do Not Write Below This Line Blue: GENERATOR SENDS THIS COPY TO DOH5 WITHIN 30 DAYS <br />To: P.O. Box 400, Sacramento, CA 95812.0400 <br />v: <br />UNIFORM HAZARDOUS enarator'a US EPA ID No. Manifest <br />Document No. <br />.Paget Information in the shaded areas <br />WASTE MANIFESTof <br />is not required by Federal law. <br />3. Generator's Name and Mailing Address <br />A. State Miliffifeg Document Number <br />Cal -Fate Supply, CIO CathE i i ie WhitVarth <br />11876 <br />B. State Generators ID <br />P.O. B� 280, Davis, ® 95616 <br />4. Generator's Phgne <br />5. Transporter I Company Name 6. US EPA ID Number <br />C. State Transporters ID <br />D. Trensportera-Phone <br />7. Transporter 2 ompany ams 8. A um er <br />E- State Transporters <br />F. Transporters Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State FajTcciility's ID <br />0- A <br />EW Eavizvomental <br />Y <br />H. Facility s Phone <br />Facility's <br />220 mina Main <br />12. Containers <br />13. Total <br />14. <br />I. <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />Quantity <br />Unit <br />Waste No. <br />No. Type <br />Wt/Vol <br />....r.' <br />a. I IQ {� 5 r`1 <br />Stet'.•] <br />•'� <br />G. <br />((±alff+arnia � Waste 40aly <br />EPA/Othe/r�. <br />E <br />24 01 <br />N <br />414� <br />E <br />b. <br />State <br />R <br />A <br />T <br />EPA/Other <br />O <br />R <br />g- <br />State <br />" <br />EPA/Other <br />- <br />d. <br />State <br />_ <br />EPA/Other. <br />J -.Additional Descriptions for Materiels Listed'Above <br />K, Handling Codes for Wastes <br />Listed Above <br />- <br />a-. <br />b. <br />t4rt600!9114t,(JiN i7rESEl � �n#2 �t7eL.oiT) <br />d <br />e" <br />;ik TCL tO� rt 5 <br />15. Special Handling Instructions and Additional InformationCA�-rArM��'� <br />Vagop[fate pxote'tive clothing 2040 N ff / o N <br />,e. <br />- GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br />and are classified, packed, marked. and labeled, and are in all respects in proper condition for transport by highway according to applicable international and <br />'. national government regulations. - <br />N 1 am a large quantity 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 <br />to be economically practicable and that I have selected the practicable method of treatment. storage, or disposal currently available to me which minimizes the. <br />present and future threat to human health and the environment; OR, if I am a small quantity generator, 1 have made a good faith effort to minimize my waste <br />generation and select the best waste management method that is available to me and that I can afford. <br />Printed/Typed Name <br />Month Day <br />Sign urej,q <br />Year <br />11 <br />v�� <br />Mt� Ralt�th as <br />,1� � � � /1 <br />Wv-r/ wY�C.� ✓l/iq 19V <br />-:, E;-4: <br />lg�.t.. <br />t7. Tre I, a - <br />K <br />Printed/Typed Name! <br />rt <br />Sign ro /���, ��� Month Day <br />1 <br />Year <br />3 <br />Warren S• �resGy <br />Q <br />P <br />O <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />R <br />T <br />Primed/Typed Name <br />Signature Month Day <br />Year <br />E <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />1 <br />T <br />20- Facility Owner or Operator Cartmcation of receipt of hazardous materials covered by this manifest except as noted in Rem 19. <br />'y <br />PRnted/Typed Name <br />Signature Month Day <br />Year <br />DHS 8022 A(7/88) -... <br />EPA 8700-22 <br />;(Rev. 9.88) Previous editions are obsolete. <br />Do Not Write Below This Line Blue: GENERATOR SENDS THIS COPY TO DOH5 WITHIN 30 DAYS <br />To: P.O. Box 400, Sacramento, CA 95812.0400 <br />v: <br />