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^State of California—Environmental Protection Agency form Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back of p Department of Toxic Substances Control Please print or type. Form designed/or use on elite(I 2pitch)Iyp Sacramento,California 1. General.(,US EPA ID No. Manifest Docamant No. 2. Page 1 Information in the shaded areas UNIFORM HAZARDOUS is not required by Federal law. WASTE MANIFEST ] S t; ( ', 6:i `! t7 G-S of ; 3 Gen .lar Name and Mailing Address A. Stale Manifest Document Number r a., 'a s. t i (140 h RtCl 3'k1 CU 'i cul fiA)IN ;i[5k'�rl:{".$ 23d'0 JJL, 1 v•+nPrq�' 'g�{{ r i v. '''f �• B. Slate Generator's ID. O 4 �aTner`afo•F4sRane is cJ}K +. N N 5. Transporter I Company Name b. US EPA ID Number C. Stole Transporter',ID[Reserved,]' sr) m 6 �1,{'3.i.i..J}7 i �R�arCA�`{ 54_({)�i e, D. Transporter'.Phone _ 7, Transporter 2 Company Name 8. US EPA ID Number E. Stale Transporter's ID[Reserved.] 77 f F. Transporter',Phone V 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID _3z it) ua'� ( ;12f33 afiT14�J..TL731:1Ca I,jls l.'dt 3j4 T;;adr! H. Fail ty's Phone �0 riif .111�N XNP, s., VJ s" 3,",s.ILl1 Q 11 US DOT Description[including Proper Shipping Name,Hazard Class,and ID Number) 12 C stainers 13. Tocol 14. Unit V No F—Type Qmmlisy Wt/Vol I. Waste Number Stale }_ °kKl3A) -'JiICN1'�1..,rBAZ;8?lS['018 KW 1:pe t;.R;.yf..l a? Eti.« ~ ltTAlifj 'r li':SYE-J�E 5T�1�[pdAf2F� �/��9tt 1 ,t �j 3 G QCs�F p EPA/Of :2t C oN I E b, stole E R EPA/Olher 4' a A f11 o Tc. Slate m O R EPA/Other -- w d. state Z w V EPA/Other w j 1 Additi�or a�ISDescriptions for Materials LisIk.Absorve a� ' r' /-^j K. Handling Codas for Wastes Listed Above 1 Q .i.e{ M't.L k r...,..-.�.. »._ iSV:kL'L t)Y... ' t 'i{ iaNiRf.s�1'r_ 1....(_ a. b. w TANK.(") WAVIC a.C'90 5:�1Lt`nLY'ID th(F7 115 3UJ" a � Js �I 7 7 3kTt#t � 3F1€A {,Aix_ 1.t41��FG€"Y d, Z 15 s e IH dl m InsIracli,m ad Addition 1I for alion O EPl °rxSil�'t VW-N LdAili�C G T`SdCfXI z 13—L t" . Z Z4 HIM? XMKI�{ac"�J�E`X I'x:�V'J f&"7 : Ara L$ "`V"s4 I:}f5t5 ,t:, .—�.8}:�3 "lr':? ,J i+ 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consig nl are fully and accurate)y described above by proper ship ing name and are classified,packed, Umarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and nalionaPgavemmenl regulations. a- If I am a large quantity generator,I certify that I have a progrum in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economicallyy w practicable and flat have selected Is practicable melhod of treatment,storage,or disposal'currently available to me which minimizes the present and Future threat to human heollh rn and the environment;OR,if I am o small quantify tor,I have made a good faith effort to minimize m 6, q y genera g y waste generation and select the best waste management method[hal is II available to ma and that l can afford. I }O Printed/Typed Name p^ Signaturep Monpth� T Days+, Year j {� w w_ i O 0 17. Transporter 1 Acknowled errant of Recei <.,:N t of Materials e:'} l''k11 fn' i � wX Pnnled/Typed N e .. a Signature + Month Day Year w 0 18. Transporter 2 Acknowledgement of Receipt of Materials O T Printed/Typed Name Signat no 7. Month Day Year w E rn 0 Q V 19. Discrepancy lndicafion Space t6 Z F 9 A C 1 L l 20. F.acih Owner or Operator Cerlificalion of receipt of hazardous materials covered b this manifest except as noted in Item 19. T Printed/Typed Name Signature Month Day Year Y ] DO NOT WRITE BELOW THIS LINE 1 DISC 8022A(1/991 EPA 8700-22 Yellow: GENERATOR RETAINS l