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State of Colefornio—Emirronmentol Protection—oency <br /> Form Approved OMB No 2050-0039(Expires 9 30 99) See Instructions on back of page 6. Department of Toxic Substances Control <br />'Please prim on designed for use ars chic f l?p+rchJ mer <br /> � Sacramento California <br /> UNIFORM HAZARDOUS I ..enerator s US EPA ID No Manifest Document s 2 Page I Information in the shaded areas <br /> WASTE MANIFEST <br /> r ; ./ J o! J✓r is not required by Federal law <br /> � � ' (.� � . <br />' 3 Generotor s Nome and Mailing Address Sit"iAAassI ! tnerd,N- <br /> C11 ROXCE TPLICY ING Vt <br /> 35 .r <br /> C H E I Z OKIKEE' RD., STOCr'lron, 1� <br /> Ln A Generators Phone ( AI A269 9211- 25-4 11 i <br /> 5 Transporter 1 Company Nome G US EPA ID Number 1W sit"1—r s a10 Reg.,v,or1 <br /> s A 2 -1s s.7 v �W, <br /> 7 Transporter 2 Company Nome B US EPA ID Number 7— MT <br /> Q wrA , <br /> V 9 Desi opted Facility Name and$rte Address 10 IUS EPA ID Number r Stale aWflAME iICLE:AN, DIC. <br /> 2570 ALM014D DR. <br /> Focih +c' <br /> SILVER C-1PP3HGTS ZV 894-29 N V11918 'q 5P 4 <br /> 11 US DOT Description(including Proper Shipping Name Hazard Class and ID Number) 12 Conlair"m 13 Total 1A Unit <br /> No Type Quantity Wt/Vol tsps <br /> aHOH-RCRA HAZARDOUS WASTE LI.toUU) f <br /> E b i 1 'T T r <br /> N <br /> ao E <br /> v R <br /> T _ <br /> T <br /> O <br /> R , h� <br /> d <br /> t <br /> t.cs <br /> ,`ildd+uonol Dascrrphani !land[ -C et <br /> Lu a <br /> AMP <br /> 15 Special Handling Instructions and Additional Information <br /> a APPRDr-RIATE PROTECTIVE CLO I HIND <br /> Z "EfIERGE11CY CONTACT, (209) 541- 9145" <br /> SEE E.R.G. 17.E <br /> 16 GENERATOR S CERTIFICATION I hereby declare that the contents of this consignment ore Fully and accurately described above by proper shipping name and ore classified pocked <br /> Q marked and labeled and are in all respects in proper condition for transport by highway according to applicable international and nor ono)government regulations <br /> IF I am a large quant+ generator I crrtiFy that I have a program in place fo reduce the volume and toxiv ty of waste ornerased to the aegree I have determined to ue ecoiomtcally <br /> practicable and thot I hove selected the pra icoble method yarn <br /> storage or disposal currently available to me which minimizes the present and future threat to humon health <br /> and the environment OR if I am a small qu�nlity generolor I have mode o good faith effort minimize my waste generation and select the best waste management method that is <br /> Of avorlable to me and that I can afford / <br /> Printed/TypedgqName JSignature ... ' Month pay Year <br /> to k/ df 'I� r/t (" ' � 7 ? <br /> r s <br /> LL' T 17 <br /> 1 transporter 1 Acknowledgement of Recei I o lerials <br /> R <br /> A Printed/Typed Nam Signature v // _ Month pay Year <br /> —711 <br /> 018 Trams iter 2 Ac nowled ement of Receipt o atenols <br /> T Printed/Typed Name — Signature <br /> Month Day Yeor <br /> Lu E <br /> R <br /> 19 Discrepancy indication Space <br /> A F <br /> C <br /> IC 20 Foci ity Owner or Operator Certification of recei 1 of hazardous materials covered 6Y this manifest except a$noted in Item 19 <br /> Panted/Typed Name Signature ° l/ Month Day Year <br /> DO NOT WRITE�RELOW THIS LINE <br /> TSC 8022A (1/99( <br /> PA 8700-22 Green TRANSPORTER RETAINS <br />