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State of'Colifornia—Environmental Protection Agency <br /> Fo ..fid OMB No.2050-0039(Expires 9-30-99) See Instructions on back 19 e fl. <br /> Department of Toxic Substances C/ntol <br /> Please print or type. Form designed For use on elite(12-pitc. ,,ewriter. Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator'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 ( �� 9 121 (� � 0 3� { of s <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> ° <br /> ft"AST RAY MUD <br /> 9031 <br /> i?,Q., H,)h 2:4055,• MS 704 <br /> O B. State Generator's ID <br /> ('.:t( 1.,ir iiT�,. r.`.A 94(ti�3--105kt <br /> 4. Czenerator's Phone( rid .}�7 _(f eq." <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> tb <br /> o '.�ihj Cil?�TLDti4.�advR'Rt�[ d.F'!'�L.r SF-,R..�t l.C.l,3 f•, ,tsrt S7 l.F 0J 11 ) L� .} D. Transporter's Phone <br /> o '�' � � (510)74.9-`1.390 <br /> ao 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID Reserved.] <br /> QF. Transporter's Phone <br /> r V 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> C A t3 2.D 12.1614 1019101 1 <br /> Yil Z <br /> 1630' 17TH H. Facility's Phone <br /> Q iONG,• 13IT'ACH` C.A 90013 2 R 4 019 0 .] 9 t 562)4 32-!;4•� <br /> tyi Q12. Containers 13. Total 14. Unit <br /> Vt�f US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol I. Waste Number <br /> Z a. wp,:c] rr,"" f bx4pysPt9l.A,31-e d..£ y "pklj9gS0- State � <br /> ~ I EPA/Other <br /> 3 G c o f �•2 !„I i s P to a <br /> t” E b• 1ghE•RCf2 <br /> o N 1tFc' p61$ tf+r1 :;7' sC,l: `f State <br /> oo E r EPA/Other� <br /> CN A t. <br /> T �c�- rs� rf �4�}rrb ?U ( � —T i) State <br /> o 35011. <br /> aoo O b%�` "1'��L D/Spos�•FRpy <br /> pt;k '�L, W,1 I ( �. ,. EPA/Other <br /> R K,1_ +rrrs c >M� nE w t a !Uj <br /> F d r(1�1kC, (kON^ S�CRS BS "4A)tp <br /> State <br /> A/ dN[� S '�J'fle'L f'Rp O@PgR!r OV mV•� 0 EPA/Other <br /> �ec'U ��q �1� ?c,�. tTrUy fir, tLU <br /> v� <br /> t kt�N +. C; 1hp AC( Or <br /> V) J Additional Descriptions for Materials Listed Above VaT .=1 y A 1CC0 SpBSrA CodeV r Wastes Listed Above tr <br /> ZO f A �i�lr + P I .. �� - - 4 : - asgy� Op'yo.4N µ'� Aon b <br /> F1B 33 9 F f x � Pardee �'w+no ��N T� '�'71T�o�' N1i� <br /> LU <br /> ttc 3y 55 VaIley , � :±f't'; `'� �c�cSto d. <br /> Z 15. Special Handling Instructions and Additional Information � � . TVI: <br /> 0 USE7y SO [li! y E llSk ! PZ, <br /> 4e <br /> Z rktz+ 14F:1t '.;Yki.`2' :;L�fU7CFl+ ry <br /> _ <br /> FT')SS D:NVTD:O331 F1N`TAI, 45301749--1.390 JON,. r,P3001% P09; A.P-30011...01 <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 /> Umarked,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 quantiy 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 /> practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> N and'Fe 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 /> O 0 availgble to me and that I can afford. <br /> Printed/Typed Name Signatufe';' Month Day Year <br /> Zitf "'",aa.T:�,. .. i7 ✓ i <br /> w T 17. Trans orter 1 Acknowled ement of Recei t of M_af_e_rials <br /> W Printed/Typed Name Signatuce��rR j f Month Day Year <br /> w <br /> $ Lw��f�- g t "] e tJ14' ' 4P� �^. N •4 .. f�✓ rt- / t <br /> w0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> T Printed/Typed Name Signature Month Day Year <br /> T <br /> U-1 E <br /> R <br /> Q <br /> U 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> I 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name F0 5'tgenat�u�r Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> (eilo�•� 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 />