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..w,n,p,u,wrwn <br /> type. norm aeargnao for urs on eUfe(12•p1feA 1ypr,vntrq• •� .r��Sacramento,Gliformr <br /> UNIFORM HAZARDOUS 1.At rMratces US EPA ID No. MuNleat Sege t <br /> WASTE MANIFEST ; � U ti 1 3 L ;y D nt' Information In 1M shaded areas <br /> �of is not required by Federal law. <br /> 3 Generator's Name and Mailing Address A. ,dais Alany@a 44 I'M b <br /> Ld•�Ilr:u... gal CJ, M <br /> !'.lJ•Lux .JdZi •'+v;i;: i,li ti.i1 y:ij:lG B. State Generators to <br /> 4. GeneratOCa Phone F-v: }+�Ir�vjl,il� • 'li • • iS X til p V <br /> Ln 5. Transporter 1 Company Name $. US EPA ID Number C. State Tranaporter's ID <br /> A Li y ii u 7 iL u <br /> a D, Transporters Phone 1, V-Wwww <br /> Ln 7. Transporter, 2 Company Name 8. US EPA ID Number E. State Tranaponers ID <br /> 1'/a:1.i 1;I L.iul 1. A J J t? 7 1 L 4.1 <br /> F. Transporters.Phone <br /> m <br /> 8. Designated Facility Name and Site Address IG. US EPA ID Number 6. State Faaipt ID <br /> >L;i'y inti L k U .� J <br /> J a L } <br /> V1•i.,r.J. �� IINt JY 1 4Ltti r1 <br /> H, Facility's Phone <br /> 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total <br /> t No. Type Quantity Unit Waste No. <br /> V a WI/Vol <br /> 7 Slats'; <br /> = G r.l.,+(� y ilL b1J.'Mit,hi liiLl: L y1Jj 1J <br /> E i.'.i� �:.: :tiv , i r i' - EPA/Ouwr <br /> N <br /> E b. <br /> R State <br /> A <br /> T <br /> N O EPA/Other <br /> r R C. <br /> S State <br /> m <br /> EPA/Other <br /> 0 <br /> w d. , <br /> I- <br /> Z Slate <br /> W <br /> EPA/fllher <br /> Z J. additional Descriptions for Materials Listed Above K. Handllno odea for Waste&Listed Above <br /> #�t7"/�Ju <br /> a. <br /> s <br /> 7 7•,may <br /> z ' <br /> 1S. Special Handling Instructions and Additional Information <br /> Z "Q <br /> r �J�Ji.�..r1[i.i rr+i.lzl'iY c+Itl�iir`ArI�Y LJirTI.C7 AUG 2 2 •" 4 <br /> �. i r {[J� -u�ua <br /> f8. -.11. - ..-.l r'. i T A 1 „I C('1 TH <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment ere July and accuratelyid4giUj obow�A opYr sh ppinp name <br />_+ and are classified,packed,marked,and labeled,and are In a8 reapects in proper condition for transport by highway according to applicable international and <br /> 1 national government regulations. <br /> 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 <br /> D to be economically practicabte-And that I have aelacted the practicable method of treatment,storage,or disposal currently available to me which minimizes the <br /> present and future threat to human health and the environment;OR,if I am a Small quantity generator,1 haus made algood faith effort to minimize my wears <br /> generation and select the beat waste magement method that Is available to me and that I can alloy¢. <br /> Printed/ odd tiagte i Signature g Month Day Year <br /> jH 17. Transponer 1 Acknowl"gemal of Receipt of materials <br /> A Printed lT ed ame ' <br /> N Signature - Month DAY Year <br /> j P ?� <br /> a O 18. Transporter 2 Acknowledgement-GyRaceiPt of Materials <br /> T Printed/Typed Name Signature <br /> E Month Day Year <br /> to. Discrepancy Indlcatioa Space <br /> F <br /> A <br /> C <br /> I <br /> f 20. Facility Owner at Operator Certification of race <br /> T ipt of hazardous materials covered by this mantlatt except as noted in Item 18. <br /> Y Printed/Typed Name <br /> Signalers Month• Day Year <br /> 13 8720 A /e$) Do Not Write Belo <br />'A 8700-222 w This line <br /> ev.8.88)Previous editions are obsolete. <br /> GREEN: HAULER RETAIN5 <br />