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State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-991 See Instructions on back of r-- Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12-pitch)ty! N%,." ��/• Sacramento,California <br /> UNIFORM HAZARDOUS 1• Generator's US EPA ID No. Manifest Document No. 2. Page 1 I Information in the shaded areas <br /> WASTE MANIFEST - is not required by Federal low. <br /> �Zl t �t 1, _ J of <br /> 3. Generator's Name and Mailing Address <br /> ,-••i-r_�_:'t';t_�-,-t,;,. 1 <br /> _ s�'F�;!r�ua:.8 .'6' R�i ,sac•+�>�s.,:.:�x�,�,..a�»° <br /> M i 7(._—r: �« <br /> _a. Generator's Phone (..` •'=' 1. -? <br /> PR * v <br /> N s <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number :CStata-T`rcnsportsCxJD: .�"' �'A 'u, - <br /> -.1 -t - ,.'�•_ ri-t� ``�-�JltF� '�v sitaa '�Y <br /> 00 Dr Transportees.Phone. <br /> aD 7. Transporter 2 Company Nome <br /> p P Y 8. US EPA ID Number SfatsT �orN/slOi: MOM <br /> 9. <br /> '- <br /> QiE':Transpo�vi'Itorr��•w. -s � '. <br /> V 9. Designated Facility Name and Site Address 10. US EPA ID Number G._•State Facility's IDS__ c Si ` <br /> ioat _ f T t H'F 1t1y�s�Pk^wter '° sem <br /> 2 -•5 <br /> to 11. US DOT Descri tion includin Pro er Shi to Name,Hazard Class,and ID Number 12. Containers 13. Total IA. Unit ,y <br /> rV P (' 9 P PP 9 1 <br /> 1Z a. No. Type Quantity Wt/Val !~ Mts• w '- <br />�� _:.,._.�.:1_i�, i-{1�._:-�r='�..s1� t�tl�•ti�._ �._.L:!.tfy` 5*" M� �, <br /> G 1 =1_,1.i.' _ T 0 -.A 1I1t1 <br /> L <br /> E <br /> o N b.co <br /> 00 <br /> Est, <br /> v R EPAt! €x <br /> v A <br /> O T c. .z <br /> co O <br /> R <br /> a< <br /> Lu d Siiale+� - i <br /> Z <br /> W ,yc <br /> UOlflest 'gyp y <br /> vi J' Additional Descriplions far Materials lilted Abave ' <br /> Z Kp., r t fiondP- W6sb <br /> . <br /> NLu <br />� t4l ltf?l�"i�� �3j t'3 y"�-.�.�"�`.``''q? - d' ,�4•.may. �ru . -,rye. _ <br /> LK <br /> Z 15. Special Handling Instructions and Additional Information <br /> ul� •i'--1'_rt')! �..... . .. -.. _..1 ?, -'J� rl. .:is. <br /> Q16. 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 /> V marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> J <br /> III am a large quantity generator,I certify that I have a prooggram in place to reduce the volume and toxicity of waste generated to the degree I haw determined to be economic 11 <br /> H practicable and that I 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 I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> ac available to me and that I con afford. <br /> OAl — <br /> U <br /> Printed/Typed Name - t i Signature• • Y <br /> ,i //, ! M1�. i l ^ Month Da eat:- <br /> yC t <br /> W T <br /> 1 ) 1 ? <br /> R 17. Transporter 1 Acknowled emenr of Recei t of Materials <br /> W R Printed/Typed Name ��•-. .,, Signature Afel ,t Month <br /> u- 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> 0 T Printed/Typed Nome Signature Month Day Year <br /> Lu <br /> E <br /> Q R <br /> V 19. Discrepancy Indication Space <br /> Z F <br />— A <br /> C <br /> I <br /> L <br /> 20. Facility Owner or Operator Certification of receiot of hazardous materials coveri s man' st elcent as noted in Item 19- <br /> T Printed/Typed Name ti-- Si nater <br /> r-� g n Month Day Year <br /> DO NOT WRITE B LOW T14S LINE. <br /> 1 � <br /> DTSC 8022A (4/97) ' <br /> EPA 8700-22 --..en: ,RETA4i 6 <br />