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Sta»YCaltfomla—Emdranme,dol Protection Agency R�CEI VED <br /> Folm Approved OMB No.2050.0039(Expires 9-30A6 <br /> Please nnt or )f See nstructions on ba f page O <br /> P type. Farm deripmd for ere on elite(fid_a)typewriter. Department of T0Xk Substances Cartrol <br /> Sacramento,CaliforniaUN FORM HAZARDOUS 1. G'enerator's u5 EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> qr " AST MANIFEST ' + is not required.by Federal ks w. ' <br /> 2 / .of # <br /> `- is Name ancLMailing Add <br /> 4. Generate r's,Phone <br /> j�S77�G+ <br /> _ 5. Transporter 1 Company Name ' 6. US EPA ID Number <br /> L # f <br /> Q 7. Transporter 2.Comparry Name ADill 824 322S. US EPA ID Number <br /> w Z 9 Designated Fadl' Nome and Site Address, 10. US EPA ID Number. <br /> N a Ei1 ORE J IL INC. <br /> t'rfQy:. <br /> CA 8456 14CC9 $ 08874 # 8 <br /> M e <br /> t + 12. Containers 13. Total 14. Unit <br /> Description ZEUS DO1 ption(including,Rfopisr Shipping Name,Hazard Class,and ID Number) <br /> No. T Qua <br /> wt/vol. <br /> Cc <br /> Co <br /> C4 RS <br /> T C. <br /> .:: . t. <br /> F , <br /> uZt d 'r <br /> "a 1Lrf <br /> Uj .: <br /> z <br /> Q -15. Special Handling Instruction and Additional Irdormation i <br /> t.Q 24 Fair En espQs>sa Tfle*ng No.:CFVAEC 1-0424-000 lm*e 13S' S�9 � <br /> z DDT ERC 3# lid PRflTEC'i EC1�1��` <br /> i w� i } <br /> �' 7�0?5" �`•// , St �' Ski 3�� <br /> 1Q GENERATOR'S CERTIRCAT.10N. I hereby declare that the contents of this consignment aro fully and aCCuralely described above by proper shipping name and dre elosefied <br /> Q' padmd,marked,and labeled,and aro in all respects in proper condition for transport by highway according to applicable international and notional gave mment-repulciti" <br /> �� tf I'am a large quantity generator, I certify that 1 have a program in place to reduce the volume and t6xicily of waste generated to the degree I have derorminad <br /> d economically practicable and thatt have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes Nse prsent and futum^ <br /> N 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!3n,....select the <br /> waste method that is available to me and that l can afford. <br /> Q nted/Typea me Sip ro Yea <br /> Z 1 17. T 1 Acknowledgement of Receipt of Materials <br /> LU A Pri /Typedq�e ro 1 Mat1Ht Day Year <br /> Ce <br /> lt ! 3 uLU <br /> .9 <br /> A <br /> u, 0 •'i8. T 2 Acknowled ement of Reesipt of Materia& <br /> i,: Printed/Typed Name nature Month Day Year <br /> j r'T E- <br /> 19. Disc Indication S `ke_ r <br /> a fear . . <br /> :� <br /> z c <br /> t E Owne or Ooorcftr Certification of receipt of hazardous riols 94yered this m e Item 19. <br /> T Si re :«. <br /> Y ,r <br /> t DO NOT WRITE BELOW THIS LINE: r* , <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br /> (Generators.who submit hazardous'wast*for.traniparf;out of state r <br /> DT5C 8022A (1/9i)`'` 'produce completed copy of this copy.and send to DTSC wd6rn 30 days.) <br /> k. EPA 8700-22. ,1R <br />