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vnmental Protection Agency <br /> ,o.2050 x-0039[Expires 9.30-99) See Instructions on back of page 6. Department of Toxic bstance C% on of <br /> Form designed for use on elite(12 itch)typr `,r. Sacramento, lifornia <br /> 1. . ator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS y G r; h �, 7 2 q is not required by Federal law. <br /> WASTE MANIFEST (I ! D a 6 8 2 %' .s 6 of � <br /> Y <br /> .r 1 3. Generator's Name and Mailing Address A. State Manifest Document Number `,ti 5 <br /> 712 <br /> ., CHE.ROKFE I.ANE B. State Generator's ID <br /> o 001, Cts 9E,2110 <br /> LOA. Generator's Phone <br /> N 5. Transporter I Company Name b. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> L <br /> as C [- A QU P I•i th 8 � 5 2 t f6 � D. Transporter's Phone ( ''t1LR I �•.�",1�Gt` <br /> O <br /> 0 <br /> r <br /> 't� 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] <br /> ` F. Transporter's Phone <br /> y J <br /> Q <br /> U 9. Designated Focili Name and Site Addre 10. US EPA ID Number G. State Facility's ID <br /> =€ CI1 iC <br /> RESOURCE E'EC r; t F:Y C• A CJ !?� + :? t• r �' u <br /> 3 Q ; � -:.AST t Ci':1 ELVO< <br /> r ;FTta ANGELES. C xh � AG�i;! L).r µ°3 fi �: % H. Facility's Phone <br /> r o rt. <br /> w <br /> 12. Containers 13. Total 14. Unit <br /> Q 11. US DOT Description(including Proper Shi ping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol I. Waste Number <br /> U <br /> State =��5-�---•— <br /> "7-c <br /> G <br /> E State <br /> o N jb. L.i�i�,Le paj.nr Relat •d frig"erial , 3, UN1263. till w'�4 <br /> co E 0CAO1 } n�J i"1 tr 1�' � ,; EPA/Other o :. -,, <br /> -4 R t/ �'. <br /> N A State <br /> o T Ff�`—i a-• b <br /> R State <br /> W d. <br /> Z EPA/Other <br /> w <br /> U <br /> LU <br /> K. Handling Codes for Wastes Listed Above <br /> to J. Additional Descriptions for Materials Listed bove <br /> Z , a. b. <br /> LO ; . ' ;9L- s� ? AOUER 'THINNER/PAINT SLUDGE d. <br /> ADD CPAP FFA bb +f� '+ t1�aE �'� � 3 �_. . C. <br /> a <br /> Z15. Special Handling Instructions and Additio al information {; y� tG}—�� [ 1 AP# 6 3?9 <br /> GLOVES, GOGGLES & PRO C;:C T'l:VE CLOTI41NG <br /> Z EMERGE19C'Y CONTACT4 CH MT€?EC <br /> = ERG#: -ft*l�Z 11E)1? "tl.e <br /> 16. GENERATOR'S CERTIFICATION: I hereb declare that the contents of this consignment are fully and accurately described above proper shipping name and are classified,pace , <br /> Vmarked,and labeled,and are in all resp cts in proper condition for transport by highway according to applicable internationall and national government regulations. <br /> If I am a large quantity generator,I certi that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economical)y <br /> a practicable and that I have selected the acticable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat t human health <br /> V) and the environment;OR,if I am a smo 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 /> ac available to me and that I can afford. <br /> r Month Day Year <br /> rinsed/Typed Name ngt5fe <br /> Z <br /> Ur A '17. Tans or or 1 Acknowled ement of t of Materials •� Month Day^ Year <br /> LLJ R PrirVed%'f ped Name $fgn°tdr 1- r r 1 c� 7 <br /> w s <br /> P <br /> 18'. Transporter 2 Acknowled ement of Recei t of Materials Month Day Year <br /> O A Printed/Typed Nome Signature <br /> N E <br /> R <br /> (Qj 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> I 20. Focili Owner or Operator Certification f recei t of hazardous materials covered b this manifest except as note in Item 19. Month Day Year <br /> T Printed/Typed Name Signature <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />