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bfote of CdlilbinYal(E%Wffy(IIfpt* hIIllI I&;Skt(klhE, (:411. 1 j`�y'q 8'J1-/ii!T. <br /> Form Approved OMB No.2050-00391Expires 9-30-99) 4 111I Im"C'11005 oBliOCI - page b. Department of Toxic Substances Contra <br /> -Pleose print or type. Fcont designed lar use on./its,112- ypewrikt ;;t)b S4 Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generates',US EPA ID No. Manifest Doc.ment No. 2. Page 1 .formation in the shaded areas <br /> WASTE MANIFEST �. of required by Federal law <br /> GA>T. � 001 3 9 13 15 3 14 10 1,, 1of <br /> 3. Generolor's Name and Mailing Address ' A. State Manifest Document N.m6er <br /> CUu("S"" NE7AI. P(N].HING 72 <br /> 0 3400 SO 1W '{}b,, 41-1 11, 39 8. Stale Generator's ID <br /> n 4. Generator's Phone$? Jr9 ,N`CA 9521b (209}463-5811 <br /> h 5. Transporter 1 Company Noma b. US EPA ID Number C. State Transport./s ID <br /> 0 <br /> 0 21 sL (;(WItlu'y EHI 1 s 2 p s D. Tronsponar's Plane ('1021':.ifi- 7°I649 <br /> 7. Transporter 2 Com Name <br /> P° P°"Y 8. UB EPA ID Number E. Stare Transporter',ID <br /> QF. Transporrer's Phone } <br /> 9. Designated Facility Nam.and Site Address 10. US EPA ID Number G. State Facility's ID <br /> �Z 21st, CAintury 1•}11 <br /> 209'i 1413v 1 sand;' UL . P:a:x1 H. Facility's Phone <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. C.rr.ers 13. Taal I A. Une <br /> yZL No. Type Quantity Wt/Vol I. Waste Number <br /> °' State <br /> Vil ehrodc aeld 80]1131]011 8 111117"5 P61t (11! BRGI(151 ( '723 <br /> 3 E O k' S G EPA/Odmr1)W2 <br /> N <br /> o N 6. Shot. <br /> m E Will RCRA d11fA8110US iAbaTB LIQUID <br /> NR 1., E• fj EPA/Other <br /> V A 5 <br /> 0 T c State <br /> 0 (! <br /> R EPA/Other <br /> d' State <br /> Z <br /> W <br /> V <br /> EPA/Other <br /> W <br /> N 1. AddiKgpal Descriptions For Materials listed <br /> Z *,r K. Handling Codes for Wastes Lisfed Above <br /> O al i1#313-Pb Bill - CN1f K tkTkSg - `1^ t# i. a ^ 'N1Cri,l.IS SHL <br /> Olt iA1R#2 2 121 <br /> a <br /> C. d. <br /> Z15. SpeGal Handling Instructions and Additional lnlormaBon <br /> O NEAR PRO110 "1011,817TITE CLJTRIN:, 51 aihd(IT RPtt'OMSE 7;UN'� 18##81 <br /> Z 648-1931 17#21 575 2777. <br /> w <br /> I <br /> t- <br /> QIb. GENERATOR'S CERTIFICATION: Iharoby dgdaro that the contents of this consignmam are fully and ocwrohaly described°hove by pmp<r shipy11.11 name°hd aredmsified,pxked, <br /> V marked,and labeled,and are in all respecbin proper condition for transport y highway according to vpp Icoble international and pati°no government regulations. <br /> If Iam°large quant# generator,I certify that have v pro ram in place ro reduce the volume and toxicity of walk ...rated to the d <br /> a y g degree I have determined to be economicallyy <br /> w am and that I ave selected the practicable method Treatment,storage,or disposal currently available to me which minimizes the present and future threat to home.heel <br /> M <br /> Cif and the environment;OR,if I am a small quantity generator,I have made a good foi,h effort to minimize my waste generation and select the best waste management method that is <br /> O available to me and thatcan afford. <br /> Printed/Typed Nome Signomre <br /> V Month Day Year <br /> month <br /> R <br /> W T <br /> U 17. Transporter Ackn A ma of h ince# f Materia s <br /> w N Primed/Typed Name Signature Year <br /> Month Day Yr <br /> N <br /> w S <br /> P01-7 <br /> OR 1 Trans r 2 Acknozvl men,of Recei t at Materials <br /> Printed/Typed Name <br /> W E Signature Montle DaY Year <br /> Q N <br /> V F 19. Discrepancy Indication Space <br /> Z A <br /> C <br /> I 20. Fisciliteno,or Or— Certification of recei t of hazardous materials covered Is this manifest except as noted in Item 19. <br /> Y Printed/Typed Name Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DISC 8022A (4/97) <br /> EPA 8700-22 Yellow: GENERATOR RETAINS <br />