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State of Gell ornip—Environ "fal Protection Agency �14 <br /> Form Approve M&No.2 0039(Expires 9-30-99) �° See Instructions on back of: 6. �\'� �y1yepartment of Toxic Substances Control <br /> Please pri pe. For r use on elite(12-pitch)r), er. \\V' Sacramento,California <br /> RM HAZARDOUS 1. Generator's US€PA)D N . Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> ASTE MANIFEST <br /> CIAII)19181316101810191215 % 11 lo of <br /> 4 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> EAST BAY MUD 23452710 <br /> P.O. BOX 24055, MS '704 <br /> _ B. State Generator's ID <br /> LO o DS Cly 946 3 1055 <br /> enera or' Phone ( �~ <br /> 510 287-11086 V <br /> sN 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> C t <br /> O D. Transporter's Phoge <br /> ow NRC ENVIRONMENTAL SERVICESC; A IR 10 10 10 10 13 10 13, 1 14 1510 00-1390 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] <br /> "f Q F. Transporter's Phone <br /> 4�Q CROSBYDesignated�Fac®V ZNC. <br /> Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> Z 163D Wtie . 17TH ST. <br /> C A n o 2 8 4 0 9 0 1 9 <br /> LONG BEACH, CA 90813 C A O 0 2'18 4 0 9 0 1 9 H. Facility's Phone <br /> LL (5f+2)4325445 <br /> Q1 2. Containers 13. Total 14. Unit <br /> V 1 US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> � /9y� PONo. Type Quantity Wt/Vol I. Waste Number <br /> V a. WA/ TF AESOI-S, Ftfj�Yfm4j3t.F. ?.1, (JMj/�5o State Zt7 <br /> 3 E X \ Q t7 I D M O O U O P EPA/Other,,,, <br /> d Fr,N b. 07E' FL441AIABLE 00f1ID5co E , 14.0,5. ��jAJOLSJ� � State <br /> 3 <br /> v R X PE7ROLEOM P STT 11,47`0 3 0AJ1g93 P�Zr oEPA/Other <br /> af A o 0 0 q P 001 p0+� <br /> C14 A <br /> C. State <br /> co T wl�lsif r'iYarloc�{ torrc cxa, 8 ilnff �q, r�, :II 135 <br /> R kO (7)Q02) , t7 ( C 1 J p EPA/Other QV <br /> LU f /( q JJ <br /> Z d NOAI- RCRA. 41248P001 it i 001 W.JSTC, 6T.011.Z o State 31 <br /> V (rti8 PAA ) � (7 Y D � Q Q q P EPA/Other^I� <br /> w <br /> N J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> Site: <br /> O ttA7.33t754 tjZ�. 126 (1x20) b: <br /> Pardee Ctr. _. _ <br /> W Ifs, i P26M+1 ,.Q f ER61% 128 (t x 3a s... r.A 95252 <br /> 1#0 026111 OZ ER6t% 157 A X5 Dls �A`s��, C. d. <br /> Twn Q t IG L 21 s}�-0 1 X 30 errs GRA(�Y�- 7, OR REUSE CRD ED HAkU AIJp <br /> Uri <br /> Z It:EN 15. Special Handling Instructions and Additional Information n� 0 TT1. <br /> Ts}�1E Fprm <br /> Q ERA! <br /> AND STAT'F RECL'tA}TO C y A r1FrW1TTi i?1F-K LP,LS ION'S OF <br /> Z 24-HR. EMERGENCY CONTACT u Pf:R,l1;7.1tT 1\7� AC'CF-fTT TS IF RF.FE-REu �� 'O\'r-�� F(tli:f: llrl}t gPPLiC'ABur >Tl q.\f' 41 41.1 p t L `, L� <br /> = NRC ENVIR(NaMENTAL (5.10P49-1390 J()B �+P40C)13` :� Iv.r�. t - s.4Rr <br /> Q 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully dnif ccurately 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 ac"din to applicable internation6-T.- national government regulations. <br /> _i <br /> 1 _ <br /> If I am a large quantity generator,I certify that I have a program in place to reduce the vo and toxicity o ste generatecho the degree I have determined to be economical)y <br /> Npracticable and that I have selected the Practicable method of treatmer#,storage,or disp+o,4 nt1y availab„�4o 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 mdge a good faith effort to rhinimize my w6s'te generation and select the best waste management method that is <br /> Oavailable to me and that I can afford. <br /> �.. Printe Typed N me I Si nre7 - ffonth/. Day Year <br /> 2 i�5 <br /> 14— <br /> Z < s L"w R 17. Trans orter 1 Acknowledgement of Receipt of Materials d V <br /> W A Printed/Typed Name Signature , _ Month Day Year <br /> w <br /> P DAFT E i- FETR0W �"`—' 4 5 1 3 0 <br /> W 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> T Printed/Typed Name Signature Month Day Year <br /> LU N E <br /> Q R <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> 20. Fac' Owner or Operator Certific ion of a of hazardous materials covered b this moAt st exce s noted in Ite 79/ <br /> f ri /Typed Name Signature M nth Day <br /> Year <br /> Y V <br /> DO NOT W _'I3E� HIS / <br /> Yellow TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A(1/99) (Generators who submit hazardous waste for transport cut-of-state, <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />