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r,rftate n:,Californio—Environmental Protection Agency <br />" Form Approved OMB No.2030-0039(Expires 9.30.96) See Instructions on back of page 6. Deportmentof Toxic Substances Cont, <br /> Please print or type. Form designed for use on elite(12-pitch)typewriter. Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST F� `1 is not required by Federal law. <br /> I of <br /> 3. Generator's Name and Mailing Address \I <br /> n ��� T, VaneiH <br /> �- <br /> 95$ .x . ' <br /> C1411 = r J�- �5 I Jc l u✓L Q`�• + j Slot f�'s ID # <br /> LO <br /> LO 4. Generator's Phone <br /> 3. Transporter 1 Gompgpy Na 6. US EPA ID Number C. State <br /> -1 C. fT�arartert �� <br /> �t i '7fl ti j} I L(in r- <br /> _, D T00 <br /> rarezporle:"s 4l� <"7e <br /> J 7. Transporter 2 Co 8. US EPA ID Nu leer y F 5 ✓ <br /> L J 1 1 C0 2 t � f l F Trdsspgetttrrtl"Phone, �. <br /> J <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G ID <br /> \\ "V <br /> .' �� <br /> W Z 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No Containers 13. Total 14. Unit <br /> — t� \ No. T Quantify Wt/Vol 1.Wucte,Number <br /> I SaAa• <br /> COte <br /> N b. Sta <br /> v E <br /> C4 R EPA/Other; <br /> A <br /> T C. State <br /> O <br /> R EPA/Other <br /> w <br /> Z d. Slee <br /> W <br /> U <br /> LU EPA/Other <br /> H I <br /> }Nantes Listed Above <br /> b. <br /> J <br /> O 15. Special Handing Instructions and Addltional information <br /> a `�� i-�1.�-( �-' 41,'_x..:,`(�C.,-� '� �. _.r ,� _� ;' ,,1.,41X - �•��5.� � _�_ r:!;;c` <br /> Z <br /> LU <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the c of this consignment are fully and accurately described above by proper shipping name and are classified, <br /> V packed,marked,and labeled,and are in all respects in proper�"ition for transport by highway according to appl'Kabk'international and rational government regulations. <br /> r <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 determined to be <br /> J <br /> d economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> H threat to human health and the environment;OR, 9 1 am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> waste management method that is available to me and that I can afford. <br /> [PrirtdlTy No. Signator Month Day Year <br /> ,. it t _L , L r_. <br /> Z R 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> LLJ <br /> (� N Printed/Typed Name Si notate Month Day Year <br /> uj <br /> w 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> It <br /> LL. 1 Pr"d�/Typed Nam ^ , ` G Sig re Month- Day- ` Ynar <br /> N19. Discrepancy Indication Space <br /> U F <br /> U A <br /> Z i ' <br /> L <br /> 1 20. Focility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except os noted in Item 19. <br /> T Printed/Typed Name Signature /- Month Day Year <br /> DO NOT WRITE BEL,6W THIS`LINE. <br /> �: rsc� ;�;��,:: -SIJ ._ � -_ �-�-_�.:-�� •.� - : <br /> DTSC 8022A (1/95) 1Ginenter, ..no ru `c7-r_c�.•. v.,.;,e 'cr --_ - <br /> EPA 8700-22 produce c^ omerect - s :c,:,, and :. _ <br />