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Pleessnot or I e. Form dev netl for use one oc r .writer. ton¢Suosla nces Control Division <br /> a Sacramento,California <br /> UNIFORM HAZARDOUS Geherator's US EPA ID No Manliest 2. Pepe 1 <br /> WASTE MANIFEST /� Documenl No. Information in the shaded areas <br /> :413101 is not required by Fed a[law. <br /> 3. Generator'a Name and Mailing Address A. State Manifest Document Number <br /> (Ta h K lie� GpA 9 4v +iR6- 0) <br /> 4. Generator's Phone(• I)JO .5 J. r L�'d T O /T� S- State Generator'.ID <br /> I �fl <br /> 5. TranalIroffer1l vjfl. S EPA ID Number C. State Transporters ID <br /> IC AiO it <br /> D. Transporters Phone <br /> 7. ran&porter 2 Company Neme S. US EPA ID Num br . State Tnneportar'e ID <br /> F Transporter's Phone <br /> 9. Designated Facility Name and Sita Addnse <br /> 10. US EPA ID Number <br /> T0..State Facility'&ID. <br /> n ) r�, G.'�,S9s <br /> It Pal. L� <br /> (/, 9S 3(s'(x H. Facility's Phone- <br /> 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number 12. Containers 13. Total i4. <br /> )- I, <br /> `l ' <br /> Quantity Waste No. <br /> a. No. Type Wt/Vo <br /> o : <br /> 3 G ate <br /> jN - - e c - - i � A/Other <br /> E b. a <br /> ti R Sten <br /> A <br /> A10ther <br /> 1K Ile.P <br /> R <br /> C. <br /> _ I fete <br /> EF* <br /> A/Other <br /> d. <br /> ate <br /> 'iP <br /> A/Other" <br /> J. Ad1lNlonal Deacdptlons for Matedds Listed Abovs K. Handling Codes fol 4etN Listed Above <br /> ,! a. b. <br /> r' <br /> C. <br /> d <br /> 16. Special Handling Instnctlons and Additional Information i <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping. <br /> nameend are classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable <br /> intern one[and national government regulations. <br /> If I 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 <br /> determined to be economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to <br /> me which minimizes the present and future threat to human health and the environment; OR, if I am a small quantity generator. I have made a good <br /> faith effort to minimize my waste generation and select the best waste management method that is available to me and that I can afford. <br /> Printed/Typed Name 71.. <br /> .I igpature L t Month Day Year <br /> . Transporter 1 Acknowledgement of eceipt of Materlals <br /> Ped/Typed Name S tur Month Day Year <br /> S <br /> P 1.26 <br /> O 18. Transporter 2'Acknowledp menl of Re eipt of Materiels ` <br /> R Printed/Typed Name <br /> Signature Monfh Day Year <br /> E <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> 1 <br /> 4 <br /> y I 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted In Hem 19. 6. <br /> TPrinted/Typed Name Sipnaliaa I. <br /> Y Month Day Year <br /> DHS 8022 A(1/87) <br /> EPA 6700-22 Yellow: TSDF SENDS THIS�CQPY TO GENERATOR WITHIN 30 DAYS INSTRUCTIONS ON THE BACK <br /> (Rev.0.86) Previous edition&ars obsolete. <br /> IN CASE OF AN EMERGENCY OR 'SPILL, CALL THE NATIONAL RESPONSE CENTER 1-800-424-8802; WITHIN CALIFORNIA CALL 1-800-852-7550 <br />