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State of California—E6viropmental Protection Agency f A X v-I Form Approved OMB No.2050-0039(Expires 9� p See Instructions all back Of F - 6. I Vn ��p'Zent of�Lic Substances Control PI ase print or type. Forrthdesigf ed for use on elite(12-pitc4J 4 er. llV//"`�� ` Salr'6mento,California T Venerators US+EPA ID NManifest Document No. 2. Page I Information in the shaded areas ;, 'UNIFORM HAZARDOUS o. is not required by Federal law. WASTE MANIFEST r. IAICI __ 6i 0 -9 (} gi ] at �1 j .t of ... 3. Generator's Name and Mailing AddressA. State Manifest Document Number E23784413 ry 4 4 1 >�ST,. 2W- ►MUD AM: C�x`I'41'HIA A.D'.ISS0i''! ��+( F 0"t3tX241155, a 70 O r B. State Generator's ID LO Y:; tS 9�1 `3-1055 4. Generato'r's Phone ( §iu PR7..1fi23 CV 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] LO CP OD. Transporter's Phone O VIR C kh..V1 R C"Nf�rsEN'i•.AL ��il;7fi'},i[G ; t; 1:� l i iY .�� C.f i f 'i X.t.r -f.._ d. c? 7. Transporter 2 Company Name B. US EPA ID Number E. State Transporter's ID[Reserved.] Y1 Q F. Transporter's Phone U 9. Designated Facility Name and Site Address 10. US EPA ID Number G. Statc'ity' ID `�"Q Cr0,ib+tic,+.CIV ertc)rt .�111 / _ t A rr 16311 W. 6 Street H. Facility's Phone t . Z5 g . 3z� . 559432•-54El $ '? _ ! fc _ Q US DOT Description(includingProper Shipping Name,Hazard Class,and ID Number 12. Containers 13. Total 14. Unit l 1U �y T p p PP g ) No. Type Quantity Wt/Vol I. Waste Number �= a.vVASff , �120jr0l. j It M•.4 r1U(L.� �,,.Ir 04050 State H 3 G., C! C f D M 0 U © s^ Q o()I EPA/OthD v.O :E b. HMA1RVOOS WIS"fC .5.,n..TD N'.O.S. CCF6k'�NlItJM� State '0/&I _ _4 R P,f t9 q, N 3a? F' : ,cry f D F_ vod�t04 vao?r ti-008 Stateo T ` W11STE PAztll RELATED Mg7E .14 L, 331 o 7J�1L6rp�� O , OQ EPA/Ot R a heOp w d. w tJ-lZ L jF A H A M F P O W '1rY I.irk, S©I State 2.y 3 C C r t, pfZ,y k T 1) C' i b Im. 0 10 f EPA/OtheM LU U) 0. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above o X37 N tru, : at. (fx�) t �P2al�l„ (1*9 1 Lf b � C Nn LU d. 332W (f ><55) C. L( d. ( q Z nm l ( f O 15. Special Handling Instructions and Add i 1` *" m�VA5 CEry F µ 1TSE� �� OR SB C7t0ID 04 '- r,c2.i 1�s] �? a R'fr r� a TTr n sr '" tirvb 16. GENERATOR'S CERTIFICATION: I hereby dec are at the contents on� u�' W111Mft,;tr f�NOjahipping name and are classified,packed, Q marked,and labeled,and are in all respects in proper condition for transport y hig O o nAb�leppt 6bkg no government regulations. 4 HAS 11,E I SAr�R,�V =2 If I am a large quantitygenerator,I certify that I have a pro ram in place to reduce the volume and toxicity of waste generatel`994 degree I have determined to be economically n- practicable and that Ihave selected the practicable method yam istorage,or disposal currently available to me which minimizes the present and future threat to human health N and the environment;OR,if I am a small quantity generator,I have mad&a good faith effor to minimize my waste generation and select the best waste management method that is available to me and that I can afford. Or /Tyr )me ' onih Day p Year V df lL It• / if l(1[ JJ Z f r L......•+ ` W T 17. Transporter 1 Acknowledgement of Receipt of Materials (2 R LLJ A Printed/ e e Signature Month Day Year NS al0 18. Transporter 2 Ackno lecl a ent of Receipt of Materials TPrinted/Typed Name Signature Month Day Year W E N R Q V 19. Discrepancy Indication Space Z F A C I _ L - 1 20. Facility Owner or O erato Certificatio f receipt of hazardous materials cot ed ' manifest except as noted in Item 19. T Printed/Typed Name f / Signature'-, onth Day Year ! DO NbT WRITE BELOW T44t )LINE. Ned_ WHS Ye ow: TSDF SENDS THIS COPY TO GEN•kOR WITHIN 30 DAYS, DTSC 8022A (1/99) i (Generators who submit hazardo us to for(fraqM out-of-state, EPA 8700-22 "- produce completed copy of this copy and sei t within 30 days.)