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State of California—Health and Welfare Agency See Instructions On UaCK OT rageo Toxic Subatances Control Divie� <br /> Fpm Approved OMB No.2060--0030(Expires 0-30-91) and Front of P-4i 7 Sacramento,Califon <br /> Pkrase print or type. Form designed for use on alit, Ditch typewriter). <br /> UNIFORM HAZARDOUS �wvrerator's US EPA ID No. Manifest 2. Page 1 Information In the shaded areas <br /> }h� hh A � ���(�� 1..�ocurq�nt, <br /> WASTE MANIFEST (1' R _I�r�fF�'7`�jL.11.LLL - of is not required by Federal law. <br /> 3. Generator's Name and Meiling Address A. State Manifest D00t;y,�pt <br /> sumbeL ALA A.VOry O6"J� Mt.tJT" N ,V rL 90370305 <br /> *14 jet r.. n( fYMM AJO S Ta AI*W retrt A 'e :'_.+ ., :, <br /> B. fifers Generators 10 <br /> 4. Generator's Phone I. ,t) )— {,— ��.,p 't ) � / <br /> 0 5. Transporter 1 Company Name e. US EPA ID Number C. State Transponer's ID f e 1f.!�' <br /> N <br /> Traasporter's Phone . . . /. _ .::S n .O <br /> 0 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter'a ID <br /> P <br /> F. Than e,Phone <br /> m 9. DesignatedFacilityName ape Site Address 10. US EPA ID Number G. Stale/Facility's ID <br /> /--�I 'X.p 01 i�N t' <br /> v I)1ti :>>V?ll A:tJFrd .+�j'c./ �•��:�'�;:+•rs'k`wM a-H�i�c` .4 Y:: 4'�/ Ii feUHtYs Phan <br /> Z <br /> Q 12. Containers 13. Total 14. 1. <br /> 0 11. US DOT Description(Including Proper Shipping Name,Hazard Claes,and ID Number) Quantity Unit Waste No. <br /> No. Type Wt/Vol <br /> �o a..d'I5 Ps f u6/ egoA"i1i'aSrrfi� <br /> G ,_ I' .11 ITA,gMr <br /> E .r... <br /> L ; E b. SUN <br /> N R <br /> Tto �MOIMr <br /> N O <br /> y Re. state <br /> m Pr <br /> W d. Ste" <br /> 1- <br /> Z <br /> EPA/01Ner <br /> U <br /> N J. Addhion id Descriptions for Materials Listed Above K.Harrah Codes fM Wast"Listed Abe" <br /> 1. -,i- e. b. <br /> W /I.J .♦ �.�.� C. it. <br /> Q <br /> Q <br /> H, 15. Special Handling Instructions and Additional Information <br /> a <br /> Z <br /> J <br /> U 18. <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 ere classified,packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and <br /> a national government regulations. <br /> m <br /> Q <br /> If I em a large calls quantity generator,I certify that I haveeler a program in place to reduce the volume and toxicity of waste greedy v to the degree ee I have determined <br /> O pr be economically practicable and that 1 have the <br /> nvir the practicable method of treatment,storage,or have <br /> made <br /> currently available to me which minimizes the <br /> generation <br /> and future threat to human t health and tee environmentt Is a H I am a smell and <br /> that <br /> 9eneretor.I have made a good faith effort to minimize my waste <br /> U <br /> generation antl select the beet waste management method That la available to me end that I can afford. <br /> w CD P toted/Typed Nam @ Signature�', Month Day Yea, <br /> LZ T 17. Transporter 1 Acknowledgement of Receipt of Materiels <br /> R <br /> A Printed/Typed Name Slgnaturg' f Month Day Yee: <br /> N <br /> 0 P .J'r. 1 , i..i.l -=RI' .� 10 1.4 e P1 <br /> LAI O 18. Transporter 2 Acknowledgement of Receipt of Materials -, <br /> Q T Printed/Typed Name Signature Month Day Year <br /> U E <br /> Z_ <br /> 19. Discrepancy indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> I 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Hem 19. <br /> T <br /> y Printed/Typed Name Signature Month Day Yee <br /> DHS 8022 A Do Not Write Below This Line <br /> EPA 8700-22 <br /> (Rev.&89)Previous editions are obsolete. <br /> YELLOW: GENERATOR RETAINS <br />