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5tate of California—Envincrum tel Protection Apanry <br /> Form Approved OMB No.2050-00391Expires9-30-99) See Instructions on back of image 6. Department of Toxic Substances Con <br /> Plenums print or type. form designed for use on elite(12-pitch)'. rifer. 'Sacramento,California <br /> UNIFORM HAZARDOUS „e6 emlo(s US EPA ID No. Manifest Document Nr/ 2. Pape 1 Information in the shaded areas <br /> —7 vi I is not required by Federal low. <br /> WASTE MANIFEST 1I Iof <br /> 3. Ce�rab/s Nome and Mq&aAddress A. Slate Manifest Document Number w A A w w <br /> ST ts� 1•.:o—�._-'O+i G..—..-ye.-A rr L- �' • 22 L 6 1 <br /> —a.'S 1 Gse �-✓ W i1.�r.a.a r vs.'C. 7'c.._ti I aT <br /> B. Stare General.,'.ID <br /> v„j 4. Ge mmor's Phos Tz <br /> n <br /> N 5. mporier 1 Comparry No 6. US EPA ID Nomber C. Stab Transporters ID[Reserved.] <br /> h � �Ls. <br /> m .ray 1 �V 1{ N V"� JC A R 0 0 0 E9 9 7 $ L 13 D. Transporter's Phone <br /> 0 <br /> m 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporfeis ID Il <br /> F. Tmnsporear's Phone _ <br /> Q <br /> U 9AL11mitVtedFaeiliy�ft0 Address 10. US EPA ID Number G. Sbte Facility's ID <br /> 5000021 ARCHER STREET <br /> H r P <br /> 40 ALwso CA %W2 c: A is 0 e e T 6 T 7 a 3 {s`fbj$ifi � o <br /> JQ I1. US DOT Description,including Proper Shipping Name,Hazard Class,and ID Number) No Containers 13. Total 14. Unit <br /> U li g W PPi^e No. T 13, Tory WIIV.l L Waste Number <br /> Z NON RCRA HAZARDOUS WASTE, Stale "L'2. <br /> 3= LIOUIG <br /> D 01 T "9?� G EPA/Other <br /> 1:4 <br /> N b' State <br /> ao E EPA/Other <br /> a R <br /> a A a Slate <br /> o T <br /> m EPA/Other <br /> R <br /> W d. State <br /> EPA/Other <br /> W <br /> ZJ11jIditional Descriptions For Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> 0 a. b. <br /> 6 <br /> N <br /> W <br /> d. <br /> Q <br /> 0 IW0FAR4F..dIEAh1EROEN6V AUTorK0* HAYWARD 510-47&-1740 FRG# t <br /> Z <br /> z <br /> W <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurate)Y described above by proper shipping name and are classified,packed, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> J <br /> If Ions a large quantity generator,I certify that have a program in place b reduce the volume and toxicity of waste generated to the degree I have determined to be economimlly <br /> ra <br /> d Pcticable and that I have selected the practicable method o treatment,storage,or disposal currently available to me which minimizes the present and future threat b human heal <br /> and the environment;OR,if I am a small quantity generator,I have made a goad faith effort b minimize wast generation bast waste management method that is <br /> ac available te ata and that I can afford. <br /> O <br /> Prin ArDU,4 }�� (� Signature <br /> Z lnlht /Day Qv QYear <br /> Z lyl <br /> T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> ad 8 <br /> E PrinNoms s, to _ /Month- Day �Y r <br /> SIT is- <br /> u- j 18. Trans rte,2 Ack ment of Receipt of Materials <br /> O R <br /> T d/Typed PrinteName Signature Month Day Year <br /> QN E <br /> V , <br /> 19. Discrepancy indication Space <br /> Z F <br /> — p <br /> C <br /> L <br /> I 20. Facili Ownor or Operator Certification of racai t of hazardous materials covered this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signabre Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />