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mareatc.anfornia—Env€ronmerrtal Protection Agency <br /> Form Approyed OMB No.2050-0039(Expires 9-30-991 <br /> Please print dr type. form designed for use on efite 02-pitch)t1 .iter. See instructions on back of page 6. <br /> Deportment of Toxic Substances Control <br /> tr 1, ,rotor's US EPA IQ No. Sacramento,California <br /> VGn <br /> RM HAZARDOUS. i Manifest Document No _ 2. Page I Information in the shaded areas <br /> STE MANIFEST 1 is not required by Federa!low. <br /> C? {) r �r=1 i of <br /> Name and Mailing Address <br /> �+ A State Ma Document Number <br /> I �ff�,rFa, ��� 24716 ,., <br /> LO ,- �t q "C C,.6[ 0&) B. State Generator's 1D <br /> Phone4 17 <br /> 1 Company Name 6. US EPA ID umber <br /> .C. StaleTransporfer'sID[Reserved.] <br /> f AN 1 ALA.EY saas�.�3TE Oil- <br /> 7. D. Transpgrter's Rhpne. <br /> 732-4645 <br /> _ 7. Transporter 2 Company_Name 8- US EPA ID Number <br /> 4th E. State Transporter',ID[Reserved.] <br /> �rCt <br /> t7 9, Designated Facility Name and Site Address F. Transporter's:Phone <br /> gg . US EPA Number G. State F <br /> � �7iA1�:�k�hlElb+' rt�3ft6h�4�1`E'h'7 10acil <br /> kity's ID <br /> .. 4 <br /> ;300 CLAWS I'�OA0 H. Facility's Phone <br /> ks, YEIRTANK, GA 95M7 I T12 <br /> ` 1. US DOT Description(including Proper Shipping Name;Hazard Class,and ID Number) tainersF(Ov <br /> 14. Unit <br /> a 7 ne Ws/Vol €. Waste Number <br /> i401'44it';R 4 HA�t��1��4,XIS V A`.k i-E: f JT.I1,tll:k State <br /> G t�II V W,43-F �7 1 f _ („ EPA/Other <br /> . . N b. �• <br /> oaDo E EEPA/016er <br /> a A m O <br /> R EPA/Other <br /> Y <br /> rJ d. <br /> 7 Slate <br /> V <br /> w .EPA/Other. <br /> 7 J. Additional Descriptians for Material's.0sted Above <br /> K. Handling Codes for Wastes Listed Above <br /> OILY WATER ° b: <br /> LU I` <br /> ac <br /> C. d_ <br /> .. <br /> 15. Specie!Handling Instructions and Additional Information <br /> tisk <br /> Q <br /> Z <br /> EMERGENCY PHONE 209-"7-8857 <br /> 16, GENERATOR'S CERTIFICATION: I hereby declare that the contents of ih€s consignment are Fully and accurately described above by proper shipring name and are classified,packed, <br /> Q morked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> V <br /> 1 If I am a large quanh generator,I certify that I have a pro rom in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economicGlly <br /> L-ti practicable and that I have selected the practicoble method o�treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> cc <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 /> 0 available to me and that I can afford, <br /> jPrinted/Typed Name (� !� Signature f F "" + F,.+� Month Day Year <br /> i..� �wf ,E'�"�✓ Gam' f;.: + . �w` �f �'y �� .✓ ...'y_.='-F,x:�.. -•.^..+.' f r" i <br /> T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> W N Printed/Typed Name Signature Month Day Year <br /> u <br /> 6..LB 1 Transom odes 2 Acknowled emerti of R cel t of Materials <br /> TPrinted/Typed Nome Signature Month r Day Year <br /> E <br /> � R <br /> F 19. Discrepancy indication Space <br /> — A <br /> C <br /> I <br /> L <br /> Printed/Typed <br /> 20. FacilityOwner or Operator Certification of receipt of hazardous materials covered h this manifest except as noted in Item 19. <br /> T ed Name <br /> / Signature Month Day Year <br /> r. <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/99) <br /> EPA 8700-22 Yellow: GENERATOR RETAINS <br /> sr. <br />