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V Slate of California—Environmental Protection Agency Farm Approved OMB No.2050-0039(Expires 9-30991 See Instructions otn 6. Department of Toxic Substances Control Please print or type. Form designed for use on elite 112-p lchl typ Sacramento,California e 1. Generator's US EPA ID Na. Manif2. Page 1 Information in the shaded areas UNIFORM HAZARDOUS is not required by Federal law. WASTE MANIFEST t v i 3 Generator's Name and Mailing Address I A. 51.1a'Manif s,l Document Number 1�4CIL lt' Qil i"Sl is l_ s' t?i k 7 d ,i{�}t lr;}? 2-3 8 i�irk�r P''j0- no .{o B. Slate Generator's ID 47) 4 (�ianei`ctor'¢PFa°na 1 >— ,� f F i •� } ,� :� e:� N 5. Transporter 1 Company Name 6. US EPA ID Number C. Slate Transporter's ID[Reserved.] PIiiLIP 1��i7 61 jON & D. Transporter's Phone R- T3` I NC t t' f a p (408)6W-0447 _ 7. Transporter 2 Company Name B. US EPA ID Number E. Stale Transporter's ID[Reserved.) J F. Transporter's Phone ^kJ V 9. Designated Facility Name and Site Address 10. US EPA ID Number G. Slate Facility's ID Z- 1:COIMY "TTI, TMAIS'1'L Y.1i ,`. O 255 RIM BLVD- ! , H. Facility's Phone ] 0 RIC33M1111, Q T11+_ 3e11S0.1 ( I ] t' , ,? . 510f23;r-7.'i9ni �y-`d 1L US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit No. I Type Quantity Wt/V.1 I. Waste Number .QZ a. State F ROR a2A f1$a'�8k XKj8 'l°14 x.90 >a1 3 G s N} c` °. I{a'91'TJ'1F u1i)1t,�E°xr� `I'Lt1�T; ) n a ,., EPA/ol —R i A. is O x o N b. slate E R EPA/Other v A o T Slate O _ R EPA/Other Y Slate Z w U EPA/Other w us, J. Additional Descriptions for Materials List d b v K. Handling Codes for Wastes Listed Above a _ a [RIVE BEW THERM WUN 15 jA9 �2-rl 2- 3 'M 94 MI1000 GAL_ t'I}P44CI1 £ d. Z 15. 5 e ia1 Handlin Instructions and Additional Information - o "PR p I'.4d y nl1t3M .MURCES of 1raP:"1'I=31s_,. z 24. FOUR MWITTOIC"Y MINI Y— AMWA.I = T41{ II LiICI1CI'I' 1i CfiC1LFLIPIG . 11°CICU F- 'J 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consig men)are fully and accurate)y described above by proper shipping name and are classified,packed, laJ marked,and labeled,and are in all respects in proper condition for transport by highway according to applica6le international and national government regulations. —s If I am a large quantity generator,I certify that hove a proggram in place to reduce the volume and toxicity of waste generated to the degree I have determined lobe economicallyy Npracticable and that I have selected the praclicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human heahh and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is available vailable to me and that I can afford. } Printed/Typed Name Signalur. 6 E g. _Y p Manch Day Year V 6 Z t.. w T 17Transporter 1 Ar6.wrd9mnrm.f Recei tot Materials as p Primed/Typed Name Signalurer Manch Day Year w P B 18. Transporter 2 Acknowled ement of Receipt of Materials O RPrinted/Typed Name TSignature�'r Month Day Year w E Q R U 19. Discrepancy Indication Space Z F _ q C 1 L 20. Facilit Owner or Operator Certification of receipt of hazardous materials covered by this manifest eme t as noted in Ilem 19. YPrinted/Typad.Name Signature Month Day Year DO NOT WRITE BELOW THIS LINE. DTSC 8022A (1/99) Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. EPA 8700-22 To: P.O. Box 400, Sacramento, CA 95812-0400