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5".01'California—EnvironmeMol Protection Agency - <br /> � . <br /> ,Form Appfaved OMB No.2050-0039(Expires 9-30-941 See Instructions on back of p--sip 6, Department of Toxic Substances Control <br /> Please print or type. 't Form designed for use on elite(12-pitch)"A1. _ Socromerp California <br /> Lj <br /> UNIFORM HAZARDOU�1-' <br /> Generator's US EPA ID No. Manifest Document Nc 2, Page 1 #nformation in the shaded areasis not required by Federal law. <br /> WASTE MANIFEST <br /> 3. Generator's Name and Mailing Address cti 4 tV�itbe - <br /> to <br /> r4 7 <br /> to <br /> 71 Mill <br /> 4. Generator's Phone( ) ,c. .� ,. ��• r �"' .1• <br /> O5. Transporter I Company Name 6. US�EPA Ip umber p ;.5 Carisf3or3si I #A _ <br /> TSansporer's: <br /> mt� e' <br /> -�+ 7. Transporter Compony Name S. US'EPA ID Number fgte;lfans"x # <br /> T r � <br /> Z 9, Designated Facility Name and Site Address 10, US EPA ID Number t % <br /> H1 ri � <br /> C\j 'Z My,"' i <br /> Ui - 12. ontainers 13. otal 14. Unit <br /> ©Z 11. US DOT Description(incl4ng Proper Shipping Name,Hazard Class,and ID Number) No. T e OuonTi Wt VoY <br /> / �i1(asfd. utrl6e k <br /> N~ a' 0 <br /> a) .. 77, A <br /> E <br /> 0Q0 N b. ir _ <br /> OP e <br /> C%1 R <br /> 0 T C. r a» <br /> :. XclU <br /> U <br /> Z e t tb r 4` K Hogrltkig Cod ;#qr W 1'ilst2rN` "vo <br /> O <br /> h <br /> z <br /> 15. Speciof Handling Instruct on nd Additional Information <br /> .r cr -r c, e 7 J. <br /> LU �J <br /> H " <br /> a 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> Q packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international laws. <br /> U <br /> .; If I am a large quantity generator, I certify that k have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treatment, storage,or disposal currentfy available to me which minimizes the present and future <br /> Nthreat to human health and the environment; OR, if S am a small quantity generator, I hove made a good faith effort to minimize my waste generation and select the best <br /> waste management method that is available to me and that I can afford <br /> Q Prit]ted/Typed Name SignatuSeTMonth Day , Year s <br /> 1 <br /> Z T 17. Trans iter 1 Acknowled ement of-Receipt of Materials <br /> R <br /> UA Printed/Typed Name Signature �� Month Day Year <br /> aS <br /> 1 0 18. Transporter 2 Acknowled ement of Receipt of Materials <br /> LU aPrinted/Typed Name Signature Month Day Year <br /> O It <br /> R <br /> W 19. Discrepancy Indication Space <br /> Q .F <br /> U A <br /> Z C <br /> I <br /> j20. FacilityOwner or Operator Certification of receipt of hazardous materials covered.by this manifest except as noted in Item 19. <br /> T PrifHed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> oTSC 8022A (7/92) y <br /> EPA.8700-22, Yellow: GENERATOR RETAINS <br /> . iI <br />