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Stop obCalifomio—�nvironmentol Protection Agency <br />Form Approved OMBAo. 2050-0039 (Expires 9-30.96) See Instructions on back )age 6. <br />• Please print or type. Form designed for use on elite (12 -pitch) typewriter. <br />C <br />If <br />to <br />n <br />C, <br />Le <br />a <br />Ci <br />L <br />OD C <br />V-' :2 <br />N <br />cc <br />m <br />4 <br />CV <br />ao <br />LU <br />W <br />F— <br />Z <br />LU <br />U <br />LU <br />N <br />Z <br />0 <br />In <br />W <br />J <br />a <br />Z <br />0 <br />a <br />Z <br />LU <br />2 <br />t— <br />J <br />a <br />U <br />J <br />J <br />CL <br />t� <br />CY <br />0 <br />U <br />Z <br />LU <br />Uj <br />W <br />Uj <br />w <br />LL - <br />0 <br />w <br />N <br />a <br />U <br />II <br />Department of Toxic Substances Control <br />Sacramento_ California <br />DO NOT WRITE BELOW THIS LINE. <br />. •_i_NEkATOR WITHIN 30 DAYS. <br />,mt hu7ordous waste for transport out-of-stote, <br />DTSC 8022A (1/95) r nT of this copy and send to DTSC within 30 days.) <br />EPA 8700-22 <br />UNIFORM HAZARDOUS <br />1. Generator's US EPA ID No. Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />WASTE MANIFEST <br />"► .} t .) 6, <br />f <br />is not required by Federal law. <br />1 <br />of <br />3. Agar's Name and Mailing Address ress <br />vr+j. <br />A. State Manifest Document Number <br />36,iM <br />11 `` j� LL <br />/`Ll ^ T" 1 t L"' �7 f C L /�'�� f t l q• l ��J <br />V <br />B. State Generator's ID <br />r13 <br />4. Generator's Phone <br />S. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter's ID <br />'-ILLILEn PETROLEUP !' I A I LID 10 1 ( 1 i. .. 111 ;; <br />D. Transporter's Phone 20$•-576-8500 <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID ' <br />F. Transporter's Phone <br />9,De '9 ated-Facility Name and Site.AddFess A 10. US EPAD Number <br />in" eo <br />G. State Facility's ID <br />Fi �v I i •'s <br />-.5T0 ALMUND 'lti• <br />STLIVEP SPIR VC'; f 0 s <br />If : � `�; g .,:. -� tf I D 19 1 f3 12 1 15 :'; r <br />Facility's Phone <br />702-577-9001 <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />Quantity <br />14. Unit <br />Wt/Vol <br />I. Waste Number':'. <br />No. <br />Type_ <br />a. ._. <br />State. 223 <br />G <br />EPA/Other <br />E <br />N <br />b. <br />State <br />E <br />R <br />EPA/Other, <br />A <br />T <br />C. <br />State <br />O <br />EPA/Other <br />R <br />d. <br />State <br />EPA/Other <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes for Wastes <br />Listed Above <br />� ( <br />b. <br />1S. Special Handling Instructions and Additional Information <br />WEAR P R 0 T EC L ,: _ o; f. <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 />packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to <br />applicable international and national government regulations. <br />If I am o large quantity generator, I certify that I have a program in place to reduce the volume and toxicity <br />of waste generated to the degree I have determined to be <br />economically practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future <br />threat to human health and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br />waste mann ement method that is available to me and that I can afford. <br />Printed/Typed NameSignature <br />Mon Da� Year ar <br />1 <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />A <br />A <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />S <br />i <br />P <br />a <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />A <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />E <br />A <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />1 <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />Y <br />_ <br />DO NOT WRITE BELOW THIS LINE. <br />. •_i_NEkATOR WITHIN 30 DAYS. <br />,mt hu7ordous waste for transport out-of-stote, <br />DTSC 8022A (1/95) r nT of this copy and send to DTSC within 30 days.) <br />EPA 8700-22 <br />