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51o1eoi Coliforria—Environmental Protection Ager.cy <br />- 2050-0037 IEx pi res 9-3U-991 See IRSff llCri ns on back-__i!/� 6. _ Department of Toxic Substances mann <br />Fob Approver! OMB Na <br />Please orint or type. Form designed for use on elite ( I2-p;tch) ty, _,vriter. - J yr�sJvQ� Sacramento, California <br />0 <br />n <br />N <br />Q? <br />O <br />ao <br />m <br />�z <br />3 <br />N <br />0 <br />m <br />co <br />v <br />N <br />V <br />O <br />0 <br />m <br />w <br />ti <br />Z <br />LLJU <br />UJ <br />z <br />0 <br />is - <br />4n 4n <br />LUCie <br />a <br />Z <br />0 <br />a <br />Z <br />LU <br />a <br />U <br />lit <br />MA <br />DO NOT WRITE BELOAt THIS LINE. <br />'-,Vhite: SDF 3ci`OS THIS <br />DTSC 8022A Id/97l- <br />Ta' v ''sax 3000, iacr n:enio. ... °3i_ <br />EPA 8700-22 - <br />I. Generator's US EPA ID No. <br />Manifest Document No. <br />2. age I <br />Information in the shaded orecs <br />j UNIFORM HAZARDOUS <br />is not required by Federal law <br />I� WASTF MANIFEST <br />` Lf <br />, of <br />3- Generator's Name and Mailing Address <br />A Slate Mortmfesl'Document Number <br />9 8 815 2 5 <br />� <br />teqerotor)�P <br />one <br />s <br />5. Transporter 1 Company Name G. US EPA ID Number <br />D <br />I <br />ra sporter's P,hane - ��-' <br />�� <br />7. n porter 2 Company ame 8. US EPA ID Number <br />•E Tronapg er �'!D r v ' <br />r z <br />IIaa <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />.e <br />G Slate Faetlt <br />} i� � <br />'F� v 6 6 3 1 <br />� a ��1 I �J <br />r'�facrll s Pfwne 4 y �� <br />l-" r KT lJ <br />Vs <br />a .wr.-._ '.v+k; d.'` r-• <br />tTotal <br />11. US DOT Description {including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13 <br />Quanfiiy <br />td Unit <br />W1/Va1 <br />,z+ <br />1„Mfaste;t326er `- <br />No. <br />Type <br />,i <br />`State.�k <br />�V %3SI0.te��t�rr <br />1 <br />fEP�Olherrr�i� �.� <br />b'. <br />r c. <br />EPA'/itfiek ` T'+ <br />E <br />1 <br />A <br />T <br />c <br />ate ? v:v 4 i <br />O <br />f7A <br />Olftgr <br />G0 <br />li <br />�. <br />d. <br />n <br />- <br />i <br />` r <br />r�mr�C3�irer <br />.•� <br />^t't f”' <br />��i.� <br />- "G # '�' <br />L Y !`4� . <br />•:tt1'..A ti: <br />r � S. :+S- Y ... i ' ' ; <br />"r <br />.y <br />1 o Tom' ` �"" l �' <br />§.t 1Y��`fi �S <br />.�.r3 ,�2'-r.�`'�5� `r ; v r°.x �, <br />15. Saed I Ha dlin Instructions and AcWitio d lnformation ^`r ^ <br />dip �ra�r��cj'r��'�jVr�s� <br />r �Q�•�r�5 ��i1 G `� I ��'Y_!✓ti-r p r Lt N'l,/�✓�l/,'fQ(J�^/ <br />� J <br />�"! / /�J 9�J -'�/ � L(,�% "Jr� / i�,fJ <br />, /� <br />�� (^�'6i/�rCJ'l. Cn✓s-QA � +J l <br />�L���vi C� <br />I& GENERATOR'S CERTIFICATION: ereby declare that the contents o this consignment are fully c <br />nd accurately described above by proper shipping name and are classified, pocked, <br />marked, and labeled, and are in all respects in proper condition far transport by highway according <br />to applicable international and national government regulations. <br />lI <br />If I am a large quantiy generator, I certify that I have,o program in place to reduce the volume <br />procficable and shot I hove salected.the ppracticable method of treatment, storage, or disposal <br />and toxicity of waste generated to the degree I have determined to be economically <br />urrenily available to me which minimizes the present and future threat to human health <br />and the environment; OR, if I am a small quantity generator, I have made a good faith effort <br />o minimize my waste generation and select the best waste management method that is <br />available to me and that { can afford. <br />nted/Typed Nome <br />SignatureJ <br />Month Day Year <br />.`-Y <br />T <br />17- Trani- orter 1 Ackrowied ement of Receipt of Moterialsr <br />A <br />P fa p d Na 5 ur <br />r/she n <br />It"t <br />i' _..... <br />Month Da Year <br />Y <br />Q <br />18. Transporter 2 Acknowledgement of Receipt of Materials Ir <br />R <br />Printed/Typed Name <br />5ignature <br />Month Day Yeor <br />H <br />P <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />L <br />20- Facility Owner or Operator Certification of receipt of hazardous materials covered by this mane <br />est exec t os noted in !tern 19- <br />2 <br />Printed/Typ <br />5ignature-� <br />Month Day Year <br />DO NOT WRITE BELOAt THIS LINE. <br />'-,Vhite: SDF 3ci`OS THIS <br />DTSC 8022A Id/97l- <br />Ta' v ''sax 3000, iacr n:enio. ... °3i_ <br />EPA 8700-22 - <br />