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State of COWO'n",a--En"ranmental Protection Agency p"sapiproQd OMB No 20560039(Ezptres 9 3696) ,-See Instructions an back of page 6 Department of Teak Svbssancss Contr= FMease print or type Form design.d for use on etilr 02 pr Am Sacramento California 16 1 UNIFORM HAZARDOUSGenerator's US EPA 10 No Manifest Docum x Page 1 lnfarmonon m the shaded arras es not required by Fade. I law WASTE MANIFEST C f 0 91811 d d o 319 '71 1 1 3 3 15 of 3 Generator s Nome and Mailing Address Stas• Dacvnred Number 95607996 i C S G sof=j O—k-•i0"ID S'. C':'L�c"' C_•r i 4 2 0 1 s State G«,.raears Its ir1 f a Generators Pfione Vit,*3- ) 579-2.:Z1 Js.�i3 V�a< ri_,L— a7 5 Transporter I Company Nome 6 US EPA IO Number C. Stake Traroporters ID600-991 mj.;'VJS'--�T�_ ' I� I] 1 17 Z '� - D TronsporM/s""'19!�16) 372-2342 I Q7 Transporter 2 Company Nome 8 US EPA ID Number E 5ttate Transporters ND , V E Tronspomi/s Phone d Z 9 Devgnated Facility Name and Site Address 10 US EPA ID Number G State FaoWs ID t % �/ 0 !/ 3V 1 "111 - =rI �'*' '. 3-11 H Faddty's Pfsorte i a �a'.�'=- �-o*�, '>a33 -N ? r3 - 17 8 (800) 874=4444 ' V .. T2 Containers 13 Total 14 Unit y Z 11 US DOT Description(including Proper Shipping Name Hazard Class and ID Number) No T Quantity wt/vol I Wade Number z a Show 2-23 RCRA CVyF37.0/ 00 E', stets}, more spec�flca,ly loerltffleQ 01yiaference rL 'favrnanlf si � Was were ecvcled In accordan I h EPA/ONeerr � t forth aoovn, r _ 00 v VVI { I Of IT C 2 Q D a 1.:(S 4- 1 JZ-0 I $tate 1 I � ) hazardous L,viaslz-- g;---e a(ea ':ri the*kecyciing efforts was al o _ LLJ c sled Irl accordance 'rf=t`� tt ��c,Isle ;�f af"CP4266 S boa IStaft EPA oth.r d PETRGLEUv1 RECYCLiIVC�CORPIRATION - I V EPA/Cfhee'- I Z J Addlhorwt Descriphom for Male � Hia�and{&.rg Co3d"e's fo._l+�Wa�ste�sb,.iMstemd Above- -f - ... IL W --w+�,"k �. - •�::x« a Z _k .s ..�} -zi : ,. a :'c1,2,•'". .rlE�:,,tet,') �,..ry 0 15 Special Handling Inshuchons and Additional Information a r SXR rMOVES cr=-MiG Z 24 T-R. 1 �'Y (SIJ7 3 874-4444 Lu x .+ 16 GENERATOR'S CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by proper slipping:same and are dasufwd Q packed marked and labeled and are in all respects in proper condition for transport by highway according to applicable iirferriahonal and national govsmmenrt rogiilahara V If I am a forge quantity generator 1 certify that f have a program in place to reduce the volume and toxicity of waste generated to the degree I have defarmned to be a economically practicable and that I have selected the prxhcable method of treatment storage or disposal currently avotlable to me which mimmizes the present and future in threat to human health and the erwtroirnenf OR d 1 am a small quo" gene.of r I have mode a good forth effort to mnmmme my waste generation and select the best I ce waste monogement method that is available to me and that I can afford 0 Prtnnad/Typed Name 7 5 � Si re � month J Day Your � 41.AL 1t c.cf.� ` CCI tJ 0 5 Z 1 17 Transporter 1 Acknowled ae"st of Receipt of Materials /' r CuA 0 �Yf ( `1 / i ! Month 'th Day Year ce � 1 Q I 11 I~ ty ll 18 Transpotter 2 Acknowledgement of Receipt of Materafs U- T Point /Typed Name Signature Month Day Year O E, L. 19 Discrepancy Indication Space Q f V A Z C I L 1 20 Fact[ Owner or Operator Certification of reset f of ha:ardiws materials covered kf this manifest ex t as noted in Item 19 16P d Name ) Signow /% / month Day Year DO NOT WRITE BELOW THIS LINE Yellow TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAY5 (Generators who submit hazardous waste for transport out of st--te DISC 8022A (1/95) produce completed copy of this copy and send to DTSC within 30 Zia,$ EPA 8706-22