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State of Cobfornio—Environmental Protection Agency <br /> Form Approved OMB No 2050-0039(Expires 9 30 991 See Instructions on back of page b Department of Toxic Substances Control <br />' Please print or type farm designed For use on elite(12 pitch)typewriter Sacramento California <br /> UNIFORM HAZARDOUS I Generator s US EPA ID No Manifest Document No 2 Page 1 Information m the shaded areas <br /> is not required by Federal law <br /> WASTE MANIFEST -7 ! of <br /> 3 Generator s Name and Mailing Address /� A Stole Manifest Document Number' Q <br /> Lltlr j1f-I r7} 17L ^f 993 V 3 2 <br /> - <br /> Lr:s 4�'� B State Generator's ID <br /> s <br />' 4 Generators Phone sr <br /> CV 5 Transporter 1 Company Name 6 US EPA ID Number C State Transporter 5-ID(Reserved] ! i i <br /> co <br /> �O <br /> V�/ j.• 1- ,,•�f L D Transporter's Phone - <br />' 7 Transporter 2 Company Name 9 US EPA ID Number E Slate Transporter s l 'Reseryed I <br /> J f_ <br /> J <br />`QF Transporters Phone <br />\ s U 9 Designated Facility Name and Site Adc,ess 10 US EPA ID Number G State Facility s 1D <br /> Ce .Z! i Off rttt H Facility s Phone <br /> 0 •" i- r � rr <br /> t 1 <br /> 12 Containers 13 Total 14 Uml �'-� <br /> V 1 1 US DOT Description(mclud�ng Proper Shipping Name Hazard Class and ID Number] No Type Quantity Wt/Vol l Waste Nvmfier <br /> z a A/uAl QL>�j � pgzij,,14,5- lVus <br />' G Lf l f/ I EPA/Other_ <br /> N E sJ4 <br /> b State"', V <br /> 0000 E 1 r <br /> v R EPA/Other <br />' v A <br /> CD T C Stair <br /> aQo O � <br /> R E.PAJOi6ir 'L' <br /> .NtJ <br /> _1 a <br />' w <br /> Z Y''r ' <br /> "' <br /> LLP n fi 3F <br /> Un J Addthoriol De'sc'riptions for Materials Listed Abo'va Rr a,s:` a r1 T`•�a,r"!" t .s.y. f 'x )4 Hondhng Codes foT Wasfes,El�afed`Aboira'A .,y ' '`ti r" fht <br /> f/` r `-%k u i r�vwle ^ee ,e-, qdF ,��. '"!%r 1�' i �F't i �' sFy F W � �, ''r l^r!£„@'rA ' ✓` ; '� 3t9/.,n.,�Tit s . .e s �}� ' ! + - I i <br /> l..er .rs`'P s r,�f -'L 3- 7 _� s ` ''� f1' +i z✓i.'yrffr fs,F`s <br /> �, ✓'?S" Y: t€^ :r`' r" t. r`k pth . t. :T s Na "r y 'c +t,{�Ff.a tiYfr"frs21 c ! 7 4�r�� s_ '1 s.' '�kr E i f «s <br /> VU <br /> 49tt< r S7tf[1•i+ , S� +s�F .S� Ti ,Aij, ' <br /> �' i-�,.,, �`+t w.* ° o dam.. r tF r '6,a f",t "t, �. 'j T a Ya 1 atK.a33s; `C tEs i 4 y!"} ay.t s i d 4 s ", <br /> i` ir'„ rtri <br /> Q yl k� E.';st'+» i ry�s✓." ; tY' Y i ,�s <br /> � { t' t. �a� li j'_,, �u r.. -'-7t s s� _ _ }.n ra.z t i3 L �• 1' ,,"r .� • � f: ++et i � s _ <br /> 0 15 Special Handling Instructions and Additional Information <br /> 7#q F Chalk-101-1 a USe' S�u.rlvrGt ��e,� 1�reCvu� trri5 zl�ri� �P� /ul /W 1 .7 (..+rl <br /> Z -111hr*4 tffr&d40r» 1;PY7 54,-&4VA E4 <br /> _ astir 0 Fat,JI X51 7 <br /> L—U 16 GENERATOR S CERTIFICATION hereby declare[hat the contents of this constgament are fully and accurately derc�ed above by proper shipping name and are classiFled packed <br /> laJ marked and lobeled and are m all respects in proper condition far transport by highway according to applicable international and notiOnol government regulations <br /> J <br /> J IF I am a forge quant y generotw I cer}ify that I have a program in place to reduce the volume and tcwcsty of wcistd,9enerated to the degree 1 have determined to be economically <br /> Npracticable one that I have selected the°procticab4 method of treatment storage or disposal currently 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 goad faith effort to minimize my waste generation and seEeci the best waste management method that is <br /> available to me and that i can afford <br /> 0 <br />' Printed/Typed No me r.- � tl16Pr` Signature f Month Day Year <br /> V ]J Y <br /> Z <br /> U(, R 17 Transporter 1 Ack wle ement of ecei of oterials <br /> LU <br /> A Printed/Typed Name Signature Month Day ", Year <br /> P l <br /> LU <br /> s+- g 18 Trans atter 2 Ac nowled ement pf ecei t a atenals <br /> 0 B Printed/Typed Name Signature Month Day Year <br /> iV E <br /> Q R <br /> ij 19 Discrepancy Indication Space ' <br /> Z F <br /> A <br /> Ic <br /> I <br /> 1 20 Foals Owner or O erot Certification of receipt of hozcrdous materials`c - nis mpnifestlexcept as noted in item 19 <br /> T Pnnied/Typed No s Signature � ` Month Day Year <br /> J DO NOT WRITE BELOW THIS LINE <br /> 1610, TSD- SEND,) THIS COa� TO GENERATOR WITHIN 30 DAYS <br /> DTSC 8022A (1/991 (Gene aro s no submit nozardous waste for transport out of state <br /> EPA 8700-22 2 cd.icr comoieted can, of this copy and send to DTSC within 30 days I <br /> I <br />