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dtechon Agency <br /> ,,039(Expires 9-30-99) See Instructions on back of page 6. Department of Toxic Su scan s ntrol <br /> designed for use on elite(12 pitch)typewriter. Sacramento,C lifornia <br /> _e 1. :star's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded a <br /> .UNIFORM HAZARDOUS is not required by Federal law <br /> WASTE MANIFEST �; of <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> pi 01 <br /> B. State Generator's ID <br /> LO <br /> A. Generator's Phone ( ) C.A <br /> f\ <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> to <br /> ao <br /> r.. JER f Di t.^ c} f D. Transporter's Phone <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] <br /> F. Transporter's Phone <br /> )U <br /> U 9. Designated Facility Name and Site Addre s 10. US EPA ID Number G. State Facility's ID <br /> ne 3160 EAS f PTCO BLVD. H. Facility's Phone <br /> )O LOS ANGELES, CA S'0023 S � 4 E'i c: (E?�) 499-7245 <br /> Q 12. Containers 13. Total 14. Unit <br /> .�U 11. US DOT Description(including Proper Sh pping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol I. Waste Number <br /> Z !i State <br /> T':hr WT7.�. T'ITL. r <br /> Ci EPA/Other � <br /> t- _ <br /> E b, State <br /> 0 E RQ, WASTE PAT.N'T RELAT .O 0iA i E-RI"Al.. S. LIS111.63, Pl:�':T 14 <br /> N R 1 nor) �217 �FA/Other <br /> 0001 <br /> C. State <br /> p O :-��, ,.. - <br /> R -z--carrs`"Z a ,' r' _ EPA/Other <br /> � "S <br /> LU d. tate <br /> Z <br /> LU <br /> U EPA/Other <br /> LU <br /> N J. Additional Descriptions for Materials Listed Above K. Handling Codes For Wastes Listed Above <br /> Q b. <br /> N s-K:+1-) r~-,-t�-�•-��.-�5•— .�-t-t���zc`---sir'-u—���`zr�� --� <br /> ce <br /> r{TI�l�etRe JFFj i#�FT k10E <br /> d. <br /> J <br /> C. <br /> Zr'�"tt 1,y"r"{."'"Y.'��•r 'f'i?!?#"""�"m`rY.:_c.:� G',. <br /> O 15. Special Handling Instructions and Additi nal Information v <br /> Z GLOVE'S. GOGGLES & PRO'T'ECTIVE CLOTHING <br /> w EMERGENCY CON ,PC's. CH KrREC 1-800-424-9300 <br /> 16. GENERATOR'S CERTIFI i47I0N: I hereb declare that the contents of tl"s,consi nment are fully and accurately described above by proper shipping name and are classified,packed, <br /> Q marked,and labeled,and are in all res cts in proper condition for transport by highway according to applicable international and national government regulations. <br /> U <br /> IF I am a large quantity generator,I cer fy 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 <br /> 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 heolth <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 /> Ce available to me and that I can afford. <br /> O <br /> y tiPted/Typed Nome Signature t Month Day i Year <br /> Z {tet C Rs:t � t i �. ,/ <br /> w T 17. Transporter 1 Acknowledgement of Recei t of Materials ' 1 <br /> w R p PrintTyped Name r+" Sigture ! J� Month! y y Year r <br /> N 1- i <br /> LU P <br /> 0 18.'Trans orter 2 Acknowledgement of Recei t of Materials ' <br /> iPrinted/Typed Name S�gna'ture c'' Month Day Year <br /> w E <br /> N R <br /> Q <br /> U F 19. Discrepancy Indication Space <br /> Z A �i <br /> C <br /> I <br /> L <br /> ( 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 Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />