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State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back of F S. Department of Toxic Substances Control <br /> Please print or ty,pe. form d,-signed for use on elite(I 2-pitch)typ Sacramento,California <br /> UNIFORM HAZARDOUS <br /> 11. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST ! .� of is not required by Federal law, <br /> 3. Generator's Nome and Mailing Addres A. State Manifest Document Number <br /> PLP ' IC ,l 23573232 <br /> O s-C ki'>'/r' %k! • i'� `moo' B. State Generator's ID <br /> LO <br /> 4. Generator's Phone <br /> v 5. Transporter 1 Company Nome 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> ;n <br /> 00 Eii lLI{ I M" ITIT' I(A <br /> D. Transporter's Phone <br /> , <br /> 0444 <br /> co 7.` ra ispo4 er 7 6mp6nyc r e TS PAD umber E. State Transporter's ID&tieffld . <br /> QF. Transporter's Phone <br /> U 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> Q <br /> Z CRT R;�.(..>"(LING SRINl.CE, lLq(._ H. Facility's Phone <br /> 0 14M. i=1AN D.R.WX <br /> Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> U No. Type Quantity Wt/Vol I. Waste Number <br /> Z a. State <br /> > NON— Its, liii,46t )IJI } rMII,, ( ` 22 <br /> EPA/Other <br /> (OiTsHIC ` <br /> .rvw,r <br /> (~ <br /> o E b' State <br /> ooE <br /> EPA/Other <br /> 4 R LI H <br /> A c State <br /> o T <br /> 0o 0 EPA/Other <br /> R <br /> cState <br /> Uj d. <br /> VEPA/Other <br /> LU <br /> Q0 J. Additional Descriptions For Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> 0 01 LY A'M.)IRBART a. b. <br /> � 1 tii <br /> iL <br /> Q Id <br /> Z 15. Special Handling Instructions and Additional Information <br /> 1.1.E <br /> Z 4.4 (-MIR WIRGRMN cU��':PI411JP ala INC—MIR !SAARI.s Mi'I:;1-1,030 1..ib.. <br /> i.t�. <br /> z Wi R. PRYI VG"L INX C'UYMT t' & XV'1dii sR.. SITF I .Ct_: 1.1d_ <br /> 16, GENERATOR's CERTIFICATION: 1 hereby declare that the contents of this consignment are Fully and accurately described above by proper shipping name and are classified,packed, <br /> <U 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,I certify that I have a program in place to reduceAe volume and toxicity of waste generated to the degree I have determined to be economical))' <br /> rs practicable and that I have selected the practicable method or treutment,storage,or disposal cur-ently ova:!cble to me which minimizes the present and future threat to human health <br /> n 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 /> OPrinted/Typed Name Signature `� '' ` Month Day Year <br /> w T 17. Transporter 1 Acknowledgement of Receipt of Materials .. —s _ �:� <br /> R <br /> LU <br /> Ported/Typed Name Signare ,t Day Year <br /> A <br /> it .2 c .r i.4, <br /> S LLJ -� ,'V1 : L' �Month <br /> , <br /> u- D 18. Transporter 2 Acknowled emenf 8f Receipt of Materials <br /> 0 T Printed/Typed Name Signature Month Day Yecr <br /> LU E <br /> N -'a <br /> V19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> I [!acilityOwner or O erator Certification of recei t of hazardous materials covered b this manifest exce t as noted in Item 19. <br /> j /Typed Name Signature FMonth Day Year <br /> Y <br /> I <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) Yellow: GENERATOR RETA r.; <br /> EPA 8700-22 <br />