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fState of California—Environmental Protection A ency .Form Approved OMB No.2050-0039(Expires -30-99) See Instructions On back of page 6. Please print or type. Form designed for use on fife(1 2- typewriter. P 9 Department of Taxi ubst n Con Sacramen ,Cali rni UNIFORM HAZARDO S 1. Generator's US EPA ID No. Manifest Docume-,slo. 2. Page 1 Information in the oded areas i . 1 is not required by F er VVASTE MANIFEST I S I 3. Generator's Name and Mailing Ai ldress A. State Manifest Document Number !✓ 1 -;tis+['� !.^,.,r 0 yd �}J - B. State Generator's ID f ^ A. Generator's Phone fV 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] OFh ��f„-•.,-.r EES. of Jr- +i +./:_;t'..}:Si:"i Etill l llll'+±CJ1cI�J �I. SERVICES r D. Transporter's Phone `� 972-5234 GAfl38 � 4 � 3 ) 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporters ID(Reserved.] QF. Transporter's Phone �a�V 9. Designated Facility Name and Site kddress 10. US EPA ID Number G. State Facility's ID (;�SQ EVIFRORIEEN 0U., IAIC. I C I AlDI 91810181317141 J'I 3 W 585C.SC1ith A''i?ti;;.$ H. Facility's Phone 0� n 241561U_ e1ev"'I:4,C.yS1 C I Al DI 91810181817141118, { A J 12. Containers 13. Total 14. Unit IIII < 11. US DOT Description(including Pro er Shipping Name,Hazard Class,and ID Number) h �V PNo. Type Quantity Wt/vol I. Waste Number Za' ` 7? - State �NASTE,LIQUID h �_. . „�. _ EPA/OtheE �. t.,., 1 O N b. State [ w E I V R EPA/Other A c State o T 0 co R EPA/Other �. E d. _ _ - State .p t Z LU V EPA/Other 1 F LU N J. Additional Descriptions for Materials fisted Above K. Handling Codes for Wastes Listed Above Z a: 6. i � ' 79 t ck� c. d. E Z15. Special Handling Instructions and Ac ditional Information O ;�i�t•- npr^ 1?.-_,..n, a Tui v _MTf(:L 1-v010'424^ 300 Ii1N1CIC8 JJ?'7 r LU t G i 51 NE .:i PROTY'_C i:_ C!f Till lj CaIeS Order4 Lw-.;JU?/ 2 t— 16. GENERATOR'S CERTIFICATION: I h rely declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, Vmarked,and labeled,and are in all aspects in proper condition For transport by highway according to applicable international and national government regulations. If I am a large quantify 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 t Cl- practicable and that I have selected In practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health j and the environment;OR,if I am a mall quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is available to me and that I can afford 0 Printld�Typed Name` Signature ! Month Day Year Z ty B 17. Transporter 1 Acknowledgement of R cei t of Materials y ` U4 Printed/Typed Name Signature Month Day Year u- a 18. Transporter 2 Acknowledgement of R cei t of Materials 0 i Printed/Typed Name Signature Month Day Year w E N R .tc f V 19. Discrepancy Indication Space (- Z F f — A i C I L 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. T Printed/Ty, ed�"ame Signature ® � !. Month Day Year DO NOT WRITE BELOW THIS LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. 22A(1/99) (Generators who submit hazardous waste for transport out-of-state, DTSC 80 EPA 87022A produce completed copy of this copy and send to DTSC within 30 days.) I z