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arm Approved OMB No.2050-0039(Expires 9-30-99) See Instructions On back OfD e 6, <br /> lease print.or.type. Form designed For use on elite(12-pitch)typewriter. Department 9 Department of Toxic Substances Control <br /> Sacramento,California <br /> UNIFORM HAZARDOUS 1 ator s US EPA ID No. Manifest Document N 2. Page I Information in the shaded areas <br /> WASTE MANIFEST is not required by Federal law. <br /> 3. Generator's Nome and Mailing Address <br /> APA L A S 7c, S A. State Manifest Document Number /� /(A <br /> y ' B. State Generator's ID <br /> A. Generator's Phone(10� ) 36 �• /S pt7 - <br /> I 5. Transporter 1 Company Nome 6. US EPA ID Number - <br /> C. Stale Transporter's ID(Reserved.] - <br /> l t � iJ/&d *V Ae PkiLl i i' t' ( D. Transporter's Phone <br /> 7. Transporter 2 Company Nome 8. US EPA ID Number E. State Transporter's ID Reserved.] <br /> F. Transportec's Phone <br /> 9. Designated Facility Nome and Site Address 10. US EPA ID Number G. State Facility's ID _ <br /> C 42 O S�o/ —Q v-& ,7—o I) <br /> /6, - - 1"71 5 41 <br /> H. Facility's Phone <br /> o.v /�r�c Gig . 90& /3 fl d & `t �rQ r e,-2 <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total IA. Unit - <br /> a. - <br /> t No. Type Quantity Wt/Vol i.'Waste Number <br /> W P4 5 T _t I` ( $4 A-t-1/f'/�'J b /� L/[�!/�dry� NOS State <br /> EE (_AA E v A- J / q 3 P qZ 6-7ZC #�Z O I O O �1 EPA/Of r <br /> b. s— <br /> E State <br /> R <br /> EPA/Other <br /> A <br /> C.T <br /> State - <br /> O <br /> R <br /> EPA/Other <br /> d. <br /> State <br /> s_A�.. <br /> EPA' <br /> /Other <br /> J. Additional Descriptions for Materials Listed Above K. Handling Codes For Wastes Listed Above y ' <br /> c d. <br /> r r. <br /> 15. Special Handling Instructions and Additional Information <br /> C�rer� >Pn�c� J�es � a'v Ste' fso0 SGw "7-;P.gS <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 /> marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> If I am a large quantity generator,f certify that I have a proggram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> practicable and that I have selected the racticoble 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 /> available to me and that I can afford. <br /> Prince /Typed Name - Signature , /_ <br /> Month ' Day Year <br /> T <br /> R 17. Trans orter 1 Acknowled ement of Receipt of Materials <br /> A Printe Typed Signature <br /> Na e - Signat <br /> R - Month Day Year <br /> S / Z3 0 <br /> P <br /> R 18. Transporter 2 Acknowledgement of Receipt of Materials - <br /> RPrinted/T ed Nome <br /> T YP _ SignatureMonth Day � Year <br /> E <br /> R <br /> 19. Discrepanrylndicafion Space .. <br /> F <br /> A <br /> C <br /> L <br /> I 20. Fa ility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name � Signature T <br /> Month - Day Year <br /> Y 4 r"4' '^r. 7 <br /> ;c e <br /> _ r- <br /> Q` OT WRITE BELOW THIS LINE. <br /> iC 8022A(1/99) <br /> F' Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> k 8700-22 To: P.O. Box 400, Sacramento, CA ' 95812-0400 <br />