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.n8"No.2050-0039(Expires 9.3"0- 9) See Instructions on back of page 6. � <br /> . type. Form designed for useten elite I%itcll typewriter. P 9 Department of xic Sill ontrol <br /> Sacrum to,Californ' <br /> UNIFORM HAZARDOUS nerator's US EPA ID No. Manifest Document 2. Page 1 Information in the sha a rens <br /> WASTE MANIFEST �• c9 is not required by Federal law. <br /> of <br /> 3. Generator's Name and Mailing Addres A. State Manifest Document Number <br /> LO14 <br /> B. State Generator's ID <br /> LO4. Generator's Phone ( I <br /> `04 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.) <br /> 00 <br /> OO t.4 ..i I( D. Transporter's Phone (�'@CI <br /> 7. Transporter 2 Company Name E. State Transporter's ID[Reserved.) ` <br /> meq! P P Y B. US EPA ID Number <br /> �y• J <br /> J Q F. Transporter's Phone <br /> V 9. Designated Facility Name and Site Addr ss 10. US EPA ID Number G. State Facility's ID <br /> LitC <br /> �Z 'j', :;_,; Pico pi.Vl3. w M <br /> ,� LOS fttS:C 1.Y r A 900/2 ,L S CA G H. Facility's Phone 4 31+tC1 499-7145 <br /> J <br /> Q 12. Containers 13. Total 14. Unit <br /> V 11. US DOT Description(including Proper S ipping Name,Hazard Class,and ID Number) <br /> No. Type Quantity Wt/Vol I. Waste Number <br /> .. W=ti-Y' s '3 s t!1!rt `�' State <br /> G EPA/Other r r i <br /> c`i E <br /> CD N RQ 0, Waste Pant: ReizaCad Materia . 3. LIN1763, K 1 scare <br /> 1 g <br /> a°Do E EPA/OTher <br /> 04 <br /> It <br /> 6 T State <br /> a0 O y' <br /> R - EPA/Other <br /> � <br /> F d. tate <br /> S <br /> Z <br /> W <br /> V EPA/Other <br /> W <br /> U) J. Additional Descriptions for Materials Listed Bove K. Handling Codes for Wastes Listed Above <br /> i( rh <br /> W +—�^�'�"r�--r�tra--•�•�e,e� ....i F > �s,t,.1 L.�- .��: �.J. <br /> QADQ pgov <br /> r_ <br /> 0 15. Special Handling Instructions and Addition 1 Information <br /> e• <.� i1& <br /> Z CLOVES, L,-,?GGLES & F'RQ EC71VE CLOTHING <br /> EMERGENCY CONTACT: CHEMTREL <br /> = ERC'I#t !�AIT2P lie)1-- 4.G'1124 <br /> 16. GENERATOR'S CERTIFICATION: I hereby eclare that the contents of this consignment are Fully and accurate)y described above by proper shipping name and are classified,packed, <br /> Vmarked,and labeled,and are in all respe is in proper condition For transport by highway according to applicable international and national government regulations. <br /> J <br /> J If I am a large quantity generator,I cerci 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 theFr cticable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> N and the environment;OR,if I am a small uantity generator,I have made a good Faith effort to minimize my waste generation and select the best waste management method that is <br /> 0 available to me and that I can afford. <br /> r Printed/Typed Name Signature Month Day Year/ <br /> W R 17. Transporter 1 Acknowled ement'of Receipt f Materials _ <br /> LU A PrinteAlZyped-Name ,/ Signafure Month Day Year <br /> N - / <br /> LU s ,, Vii'/r <br /> u- 0 18. Trans orter 2 Acknowled ement of Recei f F Materials <br /> 0 T Printed/Typed Name ignature Month Day Year <br /> w E <br /> Q R <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> — A <br /> C <br /> I <br /> L <br /> 1 20. Facili Owner or Operator Certification of r cei t of hazardous materials covered b 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) <br /> EPA 8700-22 Yellow: GENERATOR RETAINS <br />