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Seale of Cali for nia--Enviranmental Protection Agancy r
<br />Form Approved OMB No, 2050-0039 (Expires 9.30.99) Soe Instructions on back or page 6. D«pa.unent of Toric Sv60cmte5 Control
<br />Please print or type. Form designad for use on elites 112-pirch) typowrilar, " Socrome.lfo, CoIifcq,lia
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<br />DTSC 8022A 0/991
<br />EPA 8700•-22
<br />E•d ;r6ir0 BLb 602 Pja;jTUUog Uaiid
<br />Ynllow GENERATOR RETAINS
<br />e2b:60 co LT inc
<br />1, Genelaloe's US EPA ID No. Manifest Document No.
<br />2. Pogo 1
<br />Information in the shaded oraos
<br />UNIFORM HAZARDOUS
<br />is nor required by Federvl low.
<br />WASTE MANIFEST
<br />3. Generator's Name and Mailing Address
<br />Ihs71i".i !•Ish'%4'11'5 Y•1fiP.iili'�
<br />A. Stole Monifvsl Document Number 22907463
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<br />D. State Gonwolor's ID
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<br />5. Transporter 1 Company Name 6. US EPA ID Numbar
<br />C. Stole Teonsporfer's ID [Reserved.l
<br />D, Tromporters Phone
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<br />7. Transporter 2 Company Name 8. US EPA ID Numbar
<br />E. Stowe Tronsporter's ID [R-er.nd.2
<br />F. Transparloes Phone
<br />9. Designated Facility Nome and Site Address 10, US CPA ID Number
<br />G. Stara Facility's ID
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<br />H. Facility's Phone
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<br />Fi Fr -1 7-? 6"100Containers
<br />13. Total
<br />14. Unit
<br />I 1 . US DOT Description (including Proper Shippir�g Nemo, Hazard Class, and ID Number)
<br />Ouvntily
<br />Wi/Vol
<br />I. Wade Number
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<br />1. Jpr Matprivls Liste� Abpve
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<br />K. Handling Codas for Wastes
<br />Listed Above
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<br />15, Spocial Handling Inslruclions and Addilional Information
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<br />Y.stn�rgrva.:v I_'tssR+a'J f><IT-s,r<Iflti (SJ'.'ri)bt4 £.,till ti.ts'rlif ntfUl'i':f f>itil't'1'.1'Y1V1" N;JjUIIrF11:J'1' (fsf't"")
<br />16. GENERATOR'S CERTIFIGiION_ I hereby declare, that the contents of this consignment ora fully and occurntnly described ahnva by propar shipping nom, and ora classified, packed,
<br />national regularionr.
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<br />morkad, and labolad, and are in all respects ;n proper condition fu transport fsy highway according to applicable mternatiotwl and govemn+ent
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<br />If I um a large quanliy generator, f certify that I have a program in plata to reduca who volurrw and toxicity of wasto gonarated to who dograe I have d*wrmimel to 6, oconom'colly
<br />Ireolnwl, storage, or disp°wl curronlly avuilable to me which minimism the pruwnt and future threat to human health
<br />procticobla and that I hove wl*cted the practieoble method of
<br />and the environmenw; OR, if I am a small quantity gonoratw, I have mod* o good faith affort to minimixo my wade gonarotion and snlocl the best waste manogemeol melhod Ihot is
<br />ovoilable to me and ileal I can afford.
<br />Printed/Typed Name ., ignature" /
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<br />7 7. Trans wr 1 Acknowl ,mant of Racal 11 of Mot.riols
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<br />18. Trans orler 2 Acknowlod omeni of Re iipt of Materials
<br />Month Day Year
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<br />19. Discrepancy Indication Space
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<br />20. Facility Owner or OrWnInr Cprlifitntirnt of reset I of hazardous mcitediall covered by the mmon;f.l sex .ell 9s nnoted in 11 m�I 9.
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<br />Prioled/Typed Naim, Signature Month Day Yaor
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<br />DO NOT WRITE BELOW THIS LINE.
<br />DTSC 8022A 0/991
<br />EPA 8700•-22
<br />E•d ;r6ir0 BLb 602 Pja;jTUUog Uaiid
<br />Ynllow GENERATOR RETAINS
<br />e2b:60 co LT inc
<br />
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