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C <br />7 <br />C <br />U <br />Z <br />ILL <br />u_ <br />C <br />U <br />EA <br />State of California—Environmental Protection Agenticy <br />-0,4, <br />99) <br />F— Approved OMB No. 2050-0039 (Ex ;res 9 -30 - <br />See Instructions on back of page 16. <br />Please print or type. Form designed for use on elite 112-pitchl tv...,;t., Department of Toxic Substances Control <br />DO NOT WRITE BELOW THIS LINE. <br />I.-ViTiEN 30 DAYS <br />DTSC 8022A (1/99) f"I li*r11s:­11 <br />EPA 8700-22 sOY5.) <br />r. <br />a d �6-1;10 8Ltl 602 plaijiuUOR UeTlu elt,:60 E0 q1 des <br />UNIFORM HAZARDOUS <br />1. Generator's US EPA ID No. <br />Manifest Document No. <br />2. Page I <br />Information in the shaded areas <br />r <br />WASTE MANIFEST <br />I <br />is not required by Federal 1".P, <br />, <br />- <br />or <br />J. Generotcr's Name end Mailing Address <br />A. State Manifest Document Number <br />2907463 <br />B. State Generator's ID <br />4. Gonorator's. Phone <br />5. Transporter I Company Noma 6. US EPA ID N—bi,, <br />C. Stale Transporter's ID [Reserved.] <br />D. Transporter', Phone <br />. <br />i <br />7- Transport er 2 Cam pony Name S. US EPA ID Number <br />E. State Transporter's ID [Reserved.] <br />I I I I 1 <br />F. Transporter's Phone <br />9. Designated Facility Name and Site Address .10.- US -EPA ID Number <br />G. State Facility's ID <br />H. Facility's Phone <br />11. US DOT Description lincluding Proper Shipping Name, Hazard Closs-and.11) Number)— <br />12. Containers <br />13. Total <br />IA. Unit <br />No. <br />Type <br />Quantity <br />Wt/Vol <br />1. Waste Number <br />State <br />GERNIPIthe <br />E <br />. . <br />N <br />t 0 <br />state <br />E <br />RIPA/Other <br />A <br />T• <br />C. <br />State <br />0 <br />EPA/Other <br />R <br />d. <br />State <br />EI`AjOlne, <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes for Wastes Listed Above <br />0. 6. <br />c. <br />d. <br />15. Special Handling Instructions and Additional Information <br />16 GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed <br />morked, and labeled, and are in all respects in for transport by highway international <br />proper condition according <br />to applicable and nor angrgovernment regulations. <br />if I am a large quantitygenerator, I certify that I have a pro7rom in place to reduce the volume and toxicity of waste generated to the degree I have determined to be econamicall <br />practicable and that I ve selected the practicable method a treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health <br />and the environment; OR, if I am a small I have made a faith to best <br />quantity generator, good effort <br />available to me and that I can afford. <br />minimize my waste generation and select waste management method that is <br />Plinted/Typed Name 14ignaluri <br />T <br />17. Transporter I Acknowledgement of Receipt of Materials <br />It <br />A <br />PrinteOTf6cl 1J*e <br />Signature P <br />n*, -.:I Year <br />.,Day- <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />T <br />Printad/TypePrinted/Typedme <br />No <br />Month Day Year <br />E <br />RR <br />19. Discrepancy indication Space <br />F <br />A <br />C <br />I <br />L <br />1 <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br />T <br />Printed/TypecL.Nome <br />SignatureMonth <br />Day year <br />Y <br />I <br />DO NOT WRITE BELOW THIS LINE. <br />I.-ViTiEN 30 DAYS <br />DTSC 8022A (1/99) f"I li*r11s:­11 <br />EPA 8700-22 sOY5.) <br />r. <br />a d �6-1;10 8Ltl 602 plaijiuUOR UeTlu elt,:60 E0 q1 des <br />