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aivnyrs.vr..w... <br /> Form Approved OMB No.2050-0039(Expires •30.99) See Instructions on back at page 6. Department of Toxic Substances Contr <br /> Please prynt or type. Foran designed for use on elite(12-pikht` +everiter. Sacramento,California <br /> UNIFORM HAZARDOUS nerator's US EPA ID No. Manifest Documenl� 2. Page 1 Information in the shaded areas <br /> T is not required by Federal low. <br /> WASTE MANIFEST a n 17 f� d �1 ? 4 , i 6 of <br /> 3. Generators Name and Mailing Address A.—Stale Manifest Document Number <br /> 58 <br /> 97 252 <br /> 1237 S. 7TH 5T. IrJESi:?, C' 'DE"i•1c.twa -IM <br /> ht. Generators Phone( 7; q. <br /> _. _ <br /> N 5. Transporter 1 Company Nome 6. US EPA ID Number SbteTwnsporh�tlD sX <br /> � d Transporter:Pfson4 �� <br /> C i�( ' -:),E T 1i�l-- S it "� ,' !. ,t �Q9-57-C-855 <br /> p - <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E- SkftTronsporhr's•ID r,•;-. <br /> J <br /> F: jc ^apottefs Phoi�i`.= <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> r-cL �, , T J0. * 't <br /> Eao'hly"i!bons•1 t -. <br /> 4x »° <br /> _.O [-TI _ ,':]iT., . .1� ,_�,-j:tf'.7 ., :� l '7 1 - •'< 7�Q!^^'f <br /> -� ,•l 12. Containers 13. Total 14. Unit <br /> V11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol I. Waste Number <br /> -�Z a State <br /> J ..t., •,)rsr''i—�'�..i:j i'��-�,.L.�r'0n!!.Ci T Ss!t4 <br /> EPA/Other <br /> G — ,tLAT'=_" <br /> E b State <br /> o N <br /> 00 <br /> 65 E EPA/Other <br /> a R <br /> C4 AS state <br /> o T <br /> Go O EPA/Other <br /> R <br /> LU d. State <br /> Z EPA/Other <br /> V <br /> w <br /> '^ J. Additional Descriptions far Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> b. <br /> sn O <br /> LLJ C. d. <br /> J , <br /> Q <br /> O15. Special Handling Instructions and Additional Information <br /> Uj <br /> t— <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name orad are classified,packed, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and nation al government regulations. <br /> -J+ 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 determined to be economically <br /> li practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> N 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 /> available to me and that I can afford. <br /> OPrinted/Typed Name Signature--/— /�� c Month Day Year <br /> Z /s/ �• <br /> luT 17. Trans, ter I owfed ement of Receipt of Materials <br /> W R %/ Si nature '� '/ / / Month Day Year <br /> ss.s Printed/Ty ams 9 - <br /> J <br /> P <br /> 0 0 18. Transporter emen <br /> 2 Acknowled t of Rtscei t of Materials /F <br /> TPrinted/Typed Name Signature v Month Day Year <br /> w E <br /> rn R <br /> U 19, Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> 20. Foci Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT W TE BELOW TH3-t19E. <br /> Yellow. rSDF SENDS THIS COPY TO GENERATOR WITHIN ;0 DAYS. <br /> (Generators who submithazardous waste for transport .. <br /> DTSC 6022A(t/97) produce completed copy of this copy and send to DT-SC wit av>.J <br /> EPA 8700-22 <br />