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5ta1 srnio—Environmental Protection Agency <br /> rForm , ed MB No 2050-0039(Expires 9 30 99[` See Instructions on back of page 6 Department of Toxia Substances Contr <br /> PleoW F nt or typpe.form designed for use on elite(f 2 prtcA)typewriter I Socramento,Coifornia <br /> r UNIFORM' HAZARDOUS 1 Generator's US EPA ID No f Manifest Document No 2 Page 1 Information in the shaded areas <br /> F - s not required by Federal low <br /> 'WASTE MANIFEST <br /> 3 Generator s Name and Mailing Address _y A $fate MnmFesf Document Number - <br /> 226,85 '4 till <br /> Y r� �9 ` B Slate Generator's ID„ <br /> 10 4 Goneraror s Plane <br /> C9&Cf J I / ehcs 3 a'tfe� i.✓�! <br /> CV 5 Transporter 1 Company Name h U5 EPA ID Number t C State Transporter s ID[Reserved <br /> Yi Y <br /> j� } ry <br /> / U t D Transporter's Plcn ; A�^4q�, t�4 i <br /> _ 7 Transporterrl Company Name 8 US EPA ID Number E State Transporter's I [Reserved <br /> J <br /> VF Tra-. . . ,-is Phone't .'u 5 " <br /> 4 r Y ar.t <br /> V,es,gnotd Facility Name and Site Address 10 US EPA ID Number G Stare Facility's ID e 1<-- <br /> < % yn ' °', r <br /> Z <br /> OH Facility's P one, 4' <br /> U17 'US DOT Description(including Proper Shipping Name,Hazard Class and ID Number[ 12 Containers 13 Total 14 Unit ,n <br /> / � /� }l{ f / No Type Quantity Wt/Vol I-Waste Number " t` <br /> a 51a1e <br /> 3 (� f �4r I l ) '� f EPA/Other w J <br /> N E V <br /> b State' <br /> W E <br /> t7 R EpA/Other <br /> I' o T c <br /> State <br /> C> O I <br /> R EPA/Other a �, <br /> QC ° L I d <br /> LU d <br /> Z State <br /> , Z ' 4 <br /> LU s {^ <br /> V EPA/Other of <br /> u] a <br /> J Additional Descriptions For Materials L <br /> t p I Listed Above w K Handling Codes for Wastes Lieted Above` <br /> b <br /> Y J' "ti '�� i.� v w ' i Y,i s 1✓ G �' 1 i� r Ran <br /> ] f}�JAj/,r/� c d R w a H <br /> Q � 4 V* S �! ry y N wb t <br /> Z � � J � Jr <br /> 15 Special Handling Instructions and Additional Information <br /> 14,t f�1�Guv>{rr�•c 5 U / Y <br /> Z <br /> w Pi4jeejw 4T: 74C?i clew► - � <br /> Q &GENERAT R'S CERTIF CATION I hereby declare that the contents of this consignment are Fully and accuratelyy described above by proper shipping name and are classified,packed <br /> V marked and labeled and are in all respects in proper condition For transport by highway according to applicabla international and national government regulations <br /> If I aorta large quantagenerator 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 economically <br /> I N practicable and that I have selected the practicable 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 good farrK effort to minimize my waste generatiod and select the best waste management method that is <br /> Oavailable so me and that I can afford <br /> } Pnnt /Typed NarTia Signatue Month Day Year <br /> (W'> T It Trans arter Acknowled omen'of Recei t of Malanals <br /> L3 5 Printed Typo `J Signature /�— � Mond Day Year <br /> U P [I off{/R- CJ ( 1 <br /> ii 0 t8 Tr Iment of Receipt of Materials <br /> f Printed/Typed Name a Signature Month Day Year <br /> LLJ / � a <br /> VIF 19 Discrepancy Indication Space z A <br /> C <br /> L <br /> f 20 Facdi Owner or O orator Certification of receipt of hazardous materials covered by this manifest exce t as noted in Item 19 <br /> T Panted/Typed�me Signature �'�� � Month Day Year <br />' DO NOT WRl?E BELOW THIS LINE , <br /> Yellow TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br /> DTSC 8022A (1/991 (Generators who submit hazardous waste For transport out of state <br /> EPA 8700-22 Y^ produce completed copy of this copy and send to DTSC within 30 days J <br />