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State of Golifornio—Environmental Protection Agency See Instructions on back q age 6. Department of Toxic Substances Control <br /> Form Approved Or No.2050-0039(Expires 9-30-99) `I Sacramento,California <br /> Please print or type. Form designed for use on elite(12-pikh writer. <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS _t ) is not required by Federal low. <br /> WASTE MANIFEST `�" 1 °f <br /> 3. Generator's <br /> No <br /> and Mailing Address A Stole Monsfist Document Number. <br /> Jig <br /> G) •::97307210 <br /> 2/7 '� T t/ Sf/;i C,` B State 6enerabrs ID F: <br /> in 4. Generator's Phone l�C: 1 57 y_f ) > <br /> 5. Transporter 1 Company Name b. US EPA ID Number <br /> in <br /> °D 7. Tronsporter 2 Company Name 8. US EPA ID Number 51a1e jratxPorfers <br /> J F `Transporter s Pham <br /> J <br /> Q yrsD <br /> •••� G V 9. Designated Facility Nome and Site Address 10. US EPA ID Number State Paet61,,1-. <br /> ;f t~ ti L�'•4. ✓/l `}_ H Focilily's Pho <br /> r,-�n,.T7 f r✓r <br /> Q ' }}` 12. Containers 13. Total 14. Unit <br /> V 11. US DOT Description(in-ciuding Proper Shipping Nome,Hazard Class,and ID Number) Na Type Quantity Wt/Vol I: Waste Number <br /> _ State <br /> += a./4� / ��— 1 `✓S'� r'—e EPA/Other <br /> E <br /> State <br /> o N b • <br /> Go E EPA/Other <br /> v R <br /> A c State <br /> o T <br /> GO O EPA/Other <br /> R <br /> State <br /> LU d. <br /> Z EPA/Other <br /> w <br /> V <br /> LU <br /> J. Additional Descriptions for Materials Listed AbowK. Handling Codes For Wastes Listed Above <br /> ad b. <br /> W <br /> C.. d. <br /> Z 15. Special Handling Instructions and Additional Information //%. r / iL `. <br /> ^ �.. <br /> J.s 16. 'GENERATOR'S CERTIFICATION: I hereby declare that the contents df this consignment are Fully and accurately described above by'proper shipping n me and are classified,packed, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> :-j IF I 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 determined to be economicollr <br /> H practicable and that I hove selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> 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 waste management method that is <br /> ac available to me and that I can afford. _ .. <br /> O <br /> Printed/TypedNams Signature Month Day_ Year <br /> Z �c7, E' 1 - i is • it/t//w r j.. <br /> LU T 17. Tran 'rter 1 Acknow ed einent of Recei t of Materials <br /> Pripted/Typed Nome Signature %� .° `i / Month Day Year <br /> UJIW S �! / int r •�'T�7'Ii� /.(.-.K' -// :T•l 'r..+--G'•\ �� i % _ <br /> u. 6 18. Transporter 2 AcknowT o-d ement of Receipt of Materials <br /> O T Printed/Typed Name Signotufe Month Day Year <br /> esus E <br /> Q R <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> F <br /> t <br /> f 20. Facilityor or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Ont/ t Day Yeo <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellcw: TSDF SENDS TH!S COPY TO GENERATOP. WITHIN 30 DAYS <br /> (Generator: -ho submit hozardous -este for transport out <br /> DTSC 8022A(4/97) Produce Carypl ted Cady of-this copy and send tc. DTSC v ill r 3_ <br /> EPA 8700-22 <br />