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F?ECEIVEO DEC 2 1 1995 <br /> State of Cal-fornio—Environmental Protection Agenq <br /> ., Feim Approved'ONiB No.2050-0039(Expires 9-30-94) {, See instructions on back Of� may:'. 6. Department of Toxic Substances Control <br /> r Please print or type." Form designed for use on elite(72-pitch)rypewn5er. � Sacramento,California <br /> 1. Generator's US EPA ID No. Manifest Document No. 2, Page 1 Information in the shaded areas <br /> ;4 UNIFORM HAZARDOUS k is not required by Federal law. <br /> WASTE MANIFEST �CJA113191812101012101410�2 z 7 6 18 1 of 3- <br /> s <br /> 3. Generator's Name and Mailing Address i jAa Sltif6:Yi!1ati 31`:dcwC • ie <br /> DRIDG$STGHE�EIRESTOII& y t. <br /> IF <br /> in 400 N. BL 0ORA00, STOCKTON, CA 4520 ; = t i o►stc <br /> 4. Generator's Phone (303 ) 427•-4561 <br /> in00 <br /> d 5. Transporter 1 Company Name '! 6. US EPA ID Number ' f <br />'I m LftDLAK ENVIRONMENTAL SEEVICESS OF CA, 19CIr. 1A In In In lo In IS Ig 11iZil-. <br /> 7."Tfonsporter 2 Coiripany Name S. US EPA ID Number �5 f <br /> U jsfragile%«1tFi®n8" <br /> *� t <br /> 00 <br /> Z 9 . Designated Facility Name and Site Address .10. US EPA ID Number <br /> � IAiDLAK ENVIRONMENTAL SERVICES SOUTHWEST � <br /> ' , . <br /> (D0 1340 WEST LINCOLN S1'REB1' H <br /> NuPHOENIX, AE 85007- A Z D O4 9 3 1 8 O O 9 <br /> CV 12. Containers 13. Total 14. Unit <br /> Z 11. US DOT Description(including Proper Shipping Name,Hazard�Class,and ID Number) <br /> No. T e Quantity Wt/Vol .f3—Waft lhimber <br /> ON-RCRA HAKARDOUS WASTE, SOLID, (SOIL CUTTING Sj0 <br /> 3 S DI M PPa� rt:- <br /> o E65 b. 1 e' <br /> E ` P #i <br /> R <br /> T <br /> oo c. stare;' <br /> ao T " <br /> JEPAJ( fir, <br /> x <br /> Ew <br /> LU d i e <br /> I <br /> U 1p�;>;ciasr: <br /> LU <br /> .Z Jt toy n_al l ilnsfca&lfit8tft4S >��raalnralsis> salisEesi 1K <br /> uj <br /> ., <br /> Q ! <br /> ZSpecial Handling Instructions Additional Information n <br /> � 15. anons annWEAR APPROPRIATE PROTECTIVE Ct,OTHII€G WHEN €i�t�i�irlH:t KAT6RIAL <br /> a BRGI AjNIA <br /> Z <br />` W EmerggeaclContaCt: IlltotraC $ 1-840-53S-5053 (515) <br />` = Approvals: a..' FXBR0001 b. C. d. <br /> t— <br /> t 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 /> Qpacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international laws. <br /> 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 <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> CL threat to human health 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 <br /> waste management method that is available to me and that 1 can afford. <br /> It: <br /> O .Printed/Typed Name Signature Month Day Year <br /> T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> Z R <br /> LU n Prinie#fTyped Na a Signat e • �: Month bay Year <br /> N <br /> w s !y09 5�s <br /> 0 18. Transporter 2 6jknowled emen of ecei t of Materiels J <br /> (f(f a Printed/Typed Name Signature Month Day Year <br /> f U0 E <br /> LU 19. Discrepancy Indication Space <br /> N I� <br /> Q F <br /> U A <br /> Z I— <br /> L <br /> I20. FacilityOwner or O erator Certification of receipt of hazardous materials.overed b this manifest except as noted-in'Item 19. <br /> f T Printed/Typed NameMonth ay f ;ar <br />( Y 1 n✓1+ e I O� � 6 � S <br /> DO NOT,WRITE BELOW THIS LINE. <br /> f€I€I Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> I DTSC 8022A 9/92) (Generators who submit hazardous waste for transport out-of-state, <br /> If EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />