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Fo•n:Reproved OMB No. 2050-0039(Expires 9 30-8E Toxic Substances ComrPl Division <br /> Please orint or type, ' Form designed for use on elite ,itch typewriter). Sacramento, California <br /> UNIFORM HAZARDOUS 3eneralor's US EPA ID No. Manifest 2. Page + Information in the shaded areae <br /> Doc Nu, of is not required by Federal law. <br /> WASTE MANIFEST C Q Q Q 3 / <br /> c )Y 3. Generator's Name and Mailing Address A. Slate Manibet Document Number <br /> / r���•- 87434644 <br /> �4 Jo—,_" n eti A�, B. Stan Generator's IO <br /> p s. Generator's Phone(//6) 3 7?Z_ 7S3 <br /> \\N 5. Transporter 1 Company Name 8. US EPA 10 Number C. State Transporter's ID <br /> H. R yGC� <br /> '11 D. Tiam porteYe Phan <br /> .11 7. Transporter 2 Company Name 8. Uumber E. State Transporter'a Q <br /> S EPA D N <br /> oF. Transporter's Phone <br /> m 9 Designated Facility N me d Silo Ad rasa US EPA ID Number G. State Facility's ID <br /> sa;� �°tra ric& a Ia l <br /> H. Facility's Phone <br /> c 95(/10'7 41)jo�) 6- _)l - 8� 3S <br /> 12. Containers 13, Total 1a. L <br /> 0 11. US DOT Description(Including Proper Shipping Name,Hazard Class.and ID Number) Ouantity Unit Waste No. <br /> No. Type W V Vo <br /> W#5-R Cable✓S ,R<r /- ijur0 4V 5 5Y6 slab <br /> Z c / <br /> E ' / �.r� G� Ee IOlner�� <br /> ; 3 N <br /> /1 I A/ <br /> E b. two <br /> 0 <br /> R <br /> m A <br /> T EPA/Other <br /> ru ru <br /> v O e. State <br /> 0 R <br /> m <br /> EPA f Other <br /> W it SING <br /> I <br /> Z <br /> U EPA/Other <br /> w rl I I I I <br /> W J. Additional Descriptions for Materials Used Above / K. Handling Codes for Wastes Listed Above <br /> ,nj�y U/✓��RaR nu./cfp GUr�S 'a. . �nlrr, b. <br /> ?4�5$ / "J` /{> IV J/Ver. hC �fivl'p d. <br /> Z / Y nJ Vol <br /> t <br /> Z <br /> P: 15. Special Handling Instructions and Additional Information <br /> Z I•wy� u71Y <br /> w <br /> � e <br /> ¢ 8 <br /> O GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment ble fully and accurately described above by proper shipping <br /> Jname and are classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable <br /> EL international and national government regulations. - <br /> ti If 1 am a large 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 <br /> ¢O determined to be economically practicable and that I have selected the practicable method of treatment. storage, or disposal currently evadable to <br /> me which minimizes the present and future threat to human health and the environment: OR, if I am a small quantity generator. I have made a good <br /> > faith effort to minimize my waste generation and select the best waste management method that is available to me and that I can afford. <br /> U <br /> 2 <br /> w prinndf Typed Name Sign ewre Month Day Year <br /> 0 <br /> w <br /> ,27�- JDiI'I Q S 8 <br /> wT R 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> < N P (Typed Name Sign urs Month Day Year <br /> 0 S <br /> / � e � � ekSonJ a <br /> U0 OTS. Transporter 2 Acknowledgement of Receipt of Materials <br /> APrinted/Typed Name Signature Month Day Year <br /> U E <br /> Z_ <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Caroti ion of receipt of hazardous materials covered by this manifest except ea note 19. <br /> TPrinted/T N a Sipneture Month Day Year <br /> a Signmur:Y <br /> DHS 8022 A(Hart White: TSD( SEND! ISCOPY-TC) DOHC-WITHINOttKYS STRUCTIONS ON THE BACK <br /> EPA 89 86) To: P.O x 3000, Sacramento, CA 95 12 <br /> (Rev.9-88) Previous editions are obsolete. <br /> f <br />