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t State oFColr(ornra—Envrronmental Protection Agency l <br /> Form QpProved OMB No 2450-0039(Expires 9 30 991 r See Instructions on back ofd e 6. <br /> Please prtgLor ripe form designed for use on elite(12 pitch)lypewrrter h Department of Toxic Substances Ca <br /> Sacramento California <br /> UNIFORM HAZARDOUS I Generator s US EPA ID No MamfestDocument No 2 Page 1 Information to the shaded areas <br /> WASTE MANIFEST rs not required 6y Federal law <br /> M vuR 3 v ( of + <br /> 3 Generator s Name and Mailing Address A- State Manifest Document Number` <br /> Be e+0 1-1r <br /> / -- yid �llsr/r-� � !ur y! s` 7r s y45,33ry ` t <br /> j d G n; � { �GC�sG Cr B S1ate� ensrafors ID <br /> enerator.s Pe( J ,"; } -� `Y `k , `A�„y 'K 1 f . <br /> �,. f �✓ ��`!�lLf R'rh���'t- iF i 4ax+f y' F.. R .. t ' r } <br /> 5 Transporter 1 C6mpany Name 6 US EPA ID Number C.yskalgyTran;�ar'ters>,p'�e <br /> wi?'tii <br /> �i ' <br /> One } <br /> 67&ru- r <br /> Transporter 2ompany Name 8 US EPA ID Number State Tra � vrYsr,e <br /> -.e <br /> a <br /> a <br /> 9 Designated Facility Name and Site Address 10 US EPA 10 Number G State Faci rtes R) <br /> i <br /> Z <br /> ur-6,11 of 11 r ,t #�� IL V 6 6 <br /> qcr wb clays H Facilrt� hone ti <br /> i0 k' frit 1 i�} 1` J ' [ _1iL-iV KLm 101 io I S1 1 16Ql n til <br /> Q { A st <br /> V I I US DOT Description(including Containers 13 Total 14 Unit <br /> g Proper Shipping Name Hazard Class and 1D Num6erl , <br /> }p jrNo Type Quantity Wt/Vol 1 Waste Number <br /> 2 a A/(�t� P) Oilt N Y Tj Wil! (�t,f Stale j <br /> N E , <br /> W N b ti State ; <br /> co E <br /> R EPA/Other ? <br /> v A <br /> 0 T ` State y� <br /> co O <br /> R EPA/Other ` <br /> dX <br /> ` 4 <br /> w ^ <br /> d <br /> � state r <br /> Z ` <br /> w <br /> 1 EPA/Olfrer j' sk <br /> LU <br /> dd`if a L1eiC�liprfon`s far?Aat nnTtistgt Gave S d astas this Abo s vl *y Fos <br /> s K Handling Csi es for W " t <br /> �F 4 d _ Vp°� <br /> rs <br /> ` 4 ) <br /> LU <br /> 2 ' k r <br /> � <br /> Q <br /> 7 15 Special <br /> Handonstructiona and Additional Information <br /> or <br /> Se—,IV <br /> zLLJ <br /> U ' GENERATOR'S C RTIFICATI N I hereby declare that the contents of this consignment aro fully and accurately described above by proper shipping name and are classified packed <br /> marked and labeled and are in all respects in proper condition for transport ay highway according to applicable international and national government regulations <br /> J a <br /> IFI am a targe 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 defermined to 6e economically <br /> N pwdicable and that!have selected The practicable method of treatment storog� or disposal currently available to me which minimizes the present and future threat to human hecsIx <br /> and the environment OR if I am a small quantity generator I}rave made a odh effort to minimae my wastration and select the best waste manogemepi method that is <br /> 0 available b me and that J can offgrd _ s k14-=. <br /> 4- ,yt, y , �, �,Y^ sezr .:, 1=7.,..u, <br /> y P e Typed N me S gnature Month Day Year <br /> V G,,� <br /> 1s.1 T 17 Trans iter 1 A`s nowleclement of Receipt of Materials <br /> R <br /> /4, <br /> LU <br /> 11 Pante ped Nome f Signature / f Month Day Year <br /> � 0 1 raps orter 2 A knowfed ment of Receipt of Materials <br /> 0 T Primed/Typed Name Signature nature <br /> tt� E Month Day Year <br /> V] R <br /> a <br /> CJ F 19 Discrepancy Indication Space <br /> A r <br /> C <br /> 1 <br /> L <br /> 1 24 Facility Owner or Operator Certification of recei t of hazardous materials covered by this mansfesl except as note in Item 19 <br /> T Panted/Typed <br /> Signature Month Day Year <br /> 17',,e)Al <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow TSDF SENDS THIS COPY TO GENERATOR WITHIN 310 DAYS <br /> DTSC 8022A (1/99) (Generators who submit hazardous waste for tcanspc9pt out of state <br /> EPA 8700—.22 produce compleled copy of this copy and send is-15TSC within 30 days 1 <br /> I r <br />