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State of California—Environmental Protection Agency See Instructions on back cs age b. Department of Toxic Substances Control <br /> Form Approved OMB No.2050-0039(Expires 9.30.99) Sacramento,California <br /> Please print or type. Form designed For use on elite(12-pitc rifer. <br /> D Na. Manifest Document 2. Page 1 Information the shaded areas <br /> enerotor's US EPA I <br /> UNIFORM HAZARDOUS is or required by Federal law. <br /> I <br /> WASTE MANIFEST :t i' 7. _ - o <br /> A. Slate Manifest Document Number 98522776 <br /> 3. Generator's Name and Mailing Address <br /> -1 n� Ti=tl_t s�rl :?-• Ic' i. t. B. Slate Gen eratoisID <br /> hA. Generator's Phone -raj'', <br /> fi. US EPA ID Number _ C. State Transporter's ID <br /> N 5. Transporter 1 Company Name <br /> u7) - n, - 'a T' 9 - "" - - D. Tmnsporter's Phone <br /> O <br /> O e. US EPA ID Number E. State Transports/s ID <br /> m 7. Transporter 2 Company Name <br /> F. Transporters Phone <br /> Q 10. US EPA ID Number G.State Facility's ID <br /> U 9. Designated Facility Name and Site Address <br /> + "ll�l S. j(_'T iC _ H. Facility's Phone <br /> Loz <br /> rte <br /> No Containers 1 u Total Id. Unit <br /> 11. US DOT Description on linclvd ng Proper Sh pp ng Name,Hazard Class,and ID Number) No Type Quantity Wt/Vol I. Waste Number <br /> C%jDlirl t_Tf'UI T - Stp(e_'.' <br /> _ .� EPA/Other <br /> .1.1TI <br /> T3 G Stat. <br /> E <br /> i7)o N b. <br /> E EPA/Other <br /> r R <br /> smte <br /> A <br /> a. <br /> O T EPA/Other <br /> OP O <br /> R State <br /> w d. <br /> Z EPA OI er <br /> w <br /> U <br /> for Wastes Listed Above <br /> W K. Handling Codes <br /> w J. Additional Descriptions for Materials Listed Above J 6 <br /> O TANK' BOTTOM WASTE <br /> FINSFNTE a. <br /> a <br /> OI5. Special Handling Instructions and Additional Information <br /> a F . _. = r• _ . 1 N <br /> Z ra,'.', i .:,I-- - .. _ ..•t, �sl t' _Fy 'N 'yr,y(pq <br /> S ]ct. <br /> F g acked, <br /> X 16, GENERATOR'S CERTIN aTIOe in all respects etsn declare rto tthe hat <br /> conditloo for this <br /> by high oyf according to accurate <br /> able in ternafionalyand nationlalgove government regulations. <br /> p <br /> Q marked,and labeled, P proper <br /> V <br /> If am a large quaNiy generator, certify that have a program in place to reduce the volume and toxicity of waste generated to the degree have determined ro be ecmm mica y <br /> d prodica6le and theft 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 /> and the environment;OR,if am a small quantity generator, have made a good faith effort to minimae my waste generation and select the best waste management method that is <br /> d' available to me and that I can afford. <br /> O Signature'. Month Day-I year <br /> } Printed/Typed Name. - <br /> U R Pr. Trans arteNI Acknowled ement of Reny ` v c` <br /> Z <br /> ed <br /> w prof Materials Month Day.. _Yeor„- <br /> w _ <br /> r. <br /> N <br /> w 5 <br /> P ear <br /> w 0 1 B. Trans oder 2 Acknowled ement of Receior of Materials Signature Month Day <br /> O R Printed/Typed Name <br /> T <br /> W E <br /> R <br /> V19. Discrepancy Indication Space <br /> Z F <br /> — A <br /> C <br /> I <br /> Lyear <br /> 1 20, F. ill Owner or Operator Certification of recei t of hazardous marerialSignature b this manifest ezce t as note in Item 7 Month Day <br /> T Printed/Typed Name <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC B022A 1n/97) - <br /> EPA 8700-22 <br />