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' State of Caldomio—Environmental Protection Agency <br /> Form Approved OMB No 2050-0039(Expires 9 3096) See Instructions on back of page 6 Department of Toxic Substances Control <br /> Please print or type Farm designed for ase on efrie(12-pitch)typewriter Socramento California <br /> UNIFORM HAZARDOUS 1 Generators US EPA ID No Manifest Document No 2 Page 7 Information in the shaded areas <br /> is not required by Federal law <br /> WASTE MANIFEST r r) •�1 a n1r I W 7 3- of <br /> 3 Generators Name and Mailing Address " <br /> r DARPE f Fitt, INC. � a <br />' 3a S0 EL ,'.A)41'N(? CER£Se .A 95307 • i <br /> In4 Generators Phone <br /> 9 S Transporter 1 Company Nome 6 US EPA ID Number <br /> m <br /> Q7 Tronsporter 2 Company Name 8 US EPA ID Number <br /> � YY` p9w <br /> y€ Frn� <br /> Q <br /> Z 9 Designated Facility Name and Site Address 10 US EPA ID Number <br /> a AMERICLEAM, INC. <br /> ?�r7�a ALMOND DR. � <br /> v SILVER SPRINGS N 39429 Pt I V101 91312131 �j 14141 F1 3 <br /> Z 11 US DOT Description(including Proper Shipping Name Hazard Class and ID Number) N Containers 13 Total 14 Unit <br /> No Type Quantity Wt/Vol <br /> x a <br /> NON RCRA � AZA'10,911JS kiASTZ 1.I0tII0 rA to <br />' o E T ? C i <br /> 00 N b <br /> 00R <br />' d A r ssa® <br /> co T ` <br /> O <br /> UJI <br /> R <br /> Z d <br /> ur <br /> Z <br /> u <br /> d Y i Thy <br /> r 3 <br /> W <br /> Q <br /> 0 15 Special Handling Instructions and Adc!"nai Informotson PCIK-0P AT:: 749 F. CAHPTER rWAV <br /> z WEAR PRCTECTNE AFAR STUC«MN, c4 <br />' t„ VACILTrY 70?-577-9001 <br /> GENERATOR 209-537-0771 <br /> 16 GENERATOR'S CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified <br /> U packed marked and labeled and are m all respects in proper condition for transport by highway according to applicable international and national government regulations <br /> JIf 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 s <br /> a economically practicable and that I hove selected the practicable meihod of treatment storage or disposat currently available to me which minimizes the present and future <br /> tf1 threat to human he*% and the environment, OR, d I am a small qua" generator I have made a good faith effort to minimize my waste generation and select the best <br /> W waste maria ement method that is available to me and that I can afford <br /> O Panted/Typed Na Signature i r Month Day Year <br /> 6 _j <br /> , <br /> Z R 17 Trans iter cknowled iment of Receipt of MaterialsLLJ <br /> A Pnnted/Typed Name Signature r Month Day Year <br />'OC N <br /> w ? { <br /> W0 Xcina a ement Receipt of Materials w M <br />' i <br /> Pnnted/Typad Noma <br /> O Signature Month Day Year <br /> E <br /> sW 19 Discrepancy Indication Space <br /> Q F <br /> V A <br /> Z C <br /> I <br /> l 20 Fou! Owner or rotor Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19 <br /> T Prinfed/TYped Name Signature Month Day Year <br /> r � <br /> DO NOT WRITE BEL THIS LINE <br />' DTSC 8022A (1/95) Green TRANSPORTER RETAINS <br /> EPA 6700-22 <br />