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k Form Approved 01µg No 2050-0039(Expires 9 30 991 bee instructions on back at page 6 Department of Toxic Substances <br /> Pissse pnnt or type Form des,gned For use on etre(12 p,tchl fypewnrer s Sacramento California <br /> s. �04- 106QMVlu6ll <br /> Generator s US EPA ID No Manifest Document No 2 Page 1 Information m the shaded areas <br /> UNIFORM HAZARDOUS rs notrequired by federal law <br /> WASTE MANIFEST 1 # of <br /> 3 Generator s Name and Mailing Address _/_� 'A^SEfa`te oasfeyt Do[ument Numfie`ry <br /> �{� m - <br /> IN <br /> p ��l F1r P{r {/6[ s0 s, `it <br /> ETSwte ta'eneFaro±sLO <br /> "l13� <br /> to 4 Generators Pkone �# J! � ICA <br /> i('V 5 Transporter 1 Company Name , 6 US EPA ID Number {a"'`i�'n°'"sp"grgr�"' <br /> !e cars C t9 Tlesetve`cf <br /> o V'r� l3IlJI` r# .0 t1 U <br /> y 'f 4 Y.ey ry rii <br /> ao r 7 Trans rter 2 Com an Name - 8 U5 EPA iD Nertiber'r. Po P Y <br /> -' r8n3p0 'r <br /> V 9' Designoted Fdety Name and Site'Ad ress 10 US EPA ID Number <br /> � L <br /> im: 3 Uu C r i F r l 1'l ane x <br /> LL <br /> Qv r` 12 Contariiiers i3 Total 14 Un <br /> y it <br /> U <br /> it US D07 Description{including Proper Sfipprng Name Hazard Class,and ID dumber) <br /> q_ No Y pe Quonlrty _ Wt/Vol yle9%um <br /> � C � <br /> § G <br /> Lam' <br /> N � , <br /> m � k <br /> R Y - rP��7 +et '¢ <br /> A <br /> 7 a {� <br /> M <br /> R k "e y <br /> l M. <br /> LU <br /> W <br /> tin" sct # Ma r listed �`ntjyCoYe�sfo a�teL $� <br /> i a <br /> - <br /> u 4Z <br /> 15 ^SpecwlHandlm#gvinst tiro'} andAddlhonolIafoymattion" <br /> Q a a <br /> Ud <br /> a 16 ,GENERATORS ERTIFICATION 1 hereby decfaie that the contents of this consignment are Fully and acgartilafyy described above 6y proper shipping name and are classified packed, <br /> Vmarked and labeled and are in all respects itt pno cir condition for transport by highway according to applicabfa international and national government regulations <br /> f tf t am a targe quiontity generator 1 certify that P ubsve a program m place to reduce the volume qnd ft*icty of waste generated to the degree I have determined totbe eonomicdi , <br /> Pprachca6le qnd that t have selected the practicable method of treatment,ftora�a`or dtsposaf currently available la me which mint mixes the present and Future threat to human'healt <br /> the environment,OR,Lf 1 am a small quantity generator l have#riade a g h effort to mmirritze ^Y waste generation and select the best waste management method that is <br /> Cie available to me and ihat t on tsffard F s Y k hi ' <br /> O s <br /> s ,�,�,� v <br /> Pn Na n ♦ +r k - Manllf pac <br /> .ury'r' m'^'�'I.7y'E ria-jTpt rhi• r > y`i1 N ,,i { it� f { h� ]ft yYear <br /> y� -kik i ��_ `sr 'r+� i�' <br /> ttl <br /> Bd 7�Trans iter l s'Ack wfed ement of Recei f of bllatertats -r+ i <br /> w L'rFntedJT Name f - k ;i Signature Month Day, ' Year <br /> �r F, <br /> p t " <br /> Y' +s- .0, is Trart3 iter 2 Acktiowled enf of Recei t of Matenals ` <br /> f O T Pnpted/Typed Name Signature Month Day Year <br /> aLLF <br /> V i4 Descrepancy Indication Space N <br /> A <br /> 1 � <br /> f 2_ foci l' o Owner or O rotor Certification of reces t of hazardous mateii6is covered this manifttst exceipt as noted in Item 19 t <br /> .T Printec!/Typed Fame' '\ xk w $I Signature - Month '+`LDay Year <br /> F ` _ <br /> i <br /> 1 <br /> 0 NOT W ITE BELOW THIS LINE <br /> Yellow TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br /> OTSC 8022A(1/99) (Generators who submit hazardous waste for transport out of state <br /> t, EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days) <br />