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State of Cali forn ia—Erivironmental Protection Agency <br /> }orm.yp , ved OMB No.2050-0039(Expires 9-30-99) See Instructions on back of a 6. <br /> Department of Toxic Substances Con <br /> Please print or type. Form designed for use on elite(12-pitch) titer. Sacramento,California <br /> UNIFORM HAZARDOUS TIGenrator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST of <br /> 3 Generators Name and Mailing Address <br /> 9 A. Stare Manifest Document Number <br /> : ; l 1 • /' <br /> O i:• A " S 1$ <br /> rn '%t°•f_:i�ti? ' . 11 J�'.S i<4 fit" <br /> B. State Generator's ID <br /> LO d. enera r`s Ph2Sne( ] c <br /> CV 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved] <br /> LO <br /> ao <br /> O D. Transporter's Phone <br /> i E.:hf`t" i.1 yFrr; �''� �5I01749•-•1.390 <br /> CP 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] <br /> Y J <br /> F. Transporter's Phone <br /> V 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID [' <br /> . J :J _ <br /> x..x, `fy.}fi}. II ° H. Facility's Phone <br /> O 4'X4+: �!FtAt:'E•t, CA ?0@ a.3 (562)4 +2-•5445 <br /> J <br /> 12. Containers 13. Total 14. Unit <br /> Q 1, US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> V No. Type Quantity Wf/Vol I. Waste Number <br /> Z <br /> t;. '( �' i. - 'r i;44 />t t:;,• State {J <br /> r <br /> G EPA/Other <br /> O N ib•wkA;I i.!`141,:tY��"�tCI.4 Lj�(Jt„5.:.;>�� ly�j,t.'.i1., iI{f�•,"G }!4,{ State 331v Rco E <br /> t,44 r' ,. �, J EPA/Other <br /> CN <br /> O T C. t::iJ#t Iz'�•r: I I x ;'d!d;3)t:'fs� Se �. `s d State " f <br /> R J.L f+i�1 s' }t., _ t. EPA/OtherLU A° <br /> d. �e5�t1% E71�S' 9 F l- 71, State s6', <br /> LUZ <br /> V d r EPA/Other ��pp Ff <br /> LU <br /> V) J Additional Descriptions for Materials Listed Above K. Handling Codes Wastes Listed Above <br /> t440N < B �r L`V( I:Et *. a. I. b. <br /> W la it'�t� �2],—�� c><'�a f•Z� I?��d�r� �:.tr. � L <br /> fa[ gas "gra Val lnz.wi rigs, CA C)52b2 <br /> DISPQS.a r`-r'%k",TTF w' . d. 1 Lf <br /> 15. Special Handling Instructions and Additional Information <br /> T+t': Af;PfZ' {tCTA.`R, ttir`E*R!A i t taw-:4;.a 1`,>I?lV' 7 E� <br /> Z „ <br /> S Ir`, t f to trc [G"3 1 ltd 'A At t <br /> LU <br /> �A;R]� i11-: iPiz <br /> . <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 6F'e•clossgied,packed, <br /> Vmarked,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 reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> CL practicable and that I have selected the racticable method of treatment,:storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> N <br /> and the environment;OR,if I am a sma I 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 /> O <br /> Print d/Typed Name Siggofute: j Month Day Year <br /> w T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> C7 R <br /> LU p Printed/Typed Name Signature - Month Day Year <br /> w P �. r <br /> u. B 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> 0 RPrinted/Typed Name Signature Month Day Year <br /> T <br /> w E <br /> N R <br /> (a,) 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> 1 <br /> L <br /> 20. F.acili Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T PrintWTyped Name t. Signature Month- <br /> Day Year <br /> Y t r <br /> ( 11. 1 <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A (1/99) (Generators who submit hazardous waste for transport out-of-state, <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />