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State.of Califoinia—Environmental Protection Agency <br /> Fob rovep OMB No.2050-0039(Expires 9-30-99) ` See Instructions on back of a b. Department of Toxic Substances Control <br /> Pldosa et 4 bre. form designed for use on elite(12-pitch) iter. Sacramento,California <br /> TI. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Inforrtiation in the shaded areas <br /> 4jNIFORM HAZARDOUS <br /> WASTE MANIFEST r is not required by Federal law. <br /> ALOGG141 ° I9 S r 2 i of <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> P.S.S. n--,TNPAN1Y 98756062 <br /> 0 <br /> 655 -W. CMAY STREET, STOCI:TON, CA 95206 B.•State Generator's ID <br /> LO <br /> to A. Generator's Phone 945-0- 3C)2 + <br /> s(V I 5. Transporter 1 Company Name 6, US EPA ID Number C. State Transporter's ID ! <br /> CP <br /> OI RA40S �T IP�ZLT!i"t� A �IlF ��.� : t. i. t,% = ` D. Transporter'sPhone 7 <br /> r s; tr �:' � I� � �' � 7 916 371-5747 <br /> 1-5747 <br /> 7. Transporter 2 Company Name 8 US EPA ID Number E. State Transporter's ID <br /> QF. Transporter's Phone <br /> U 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> �Q ?AC"I r" R SCi;iNu- "r1T'Jf`S, b <br /> 315 ! E. PICL BLV(,. Lf;-S ANGELES, ^A 9002?-3 5 S_ H. Facility's Phone <br /> _o ' _ C 5 (800) 499-7145 <br /> DQ 1 l: US DOT Description(including Proper hipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> )U I No. I Type Quantity Wt/Vol I. Waste Number <br /> 0 Z� a. WASJ.L. 't Luki'2,jAL:i ,'_t.'..�yITT, T�:., ._ } r ;�'1 9�,— 9 <br /> _� State 224 <br /> 3 G (i'GGI) ( �r�P�k ...;;r��,lla�t�� ItiAE?:�45r12S' t / EPA/Other <br /> G D0o1- <br /> Eb — State <br /> o N ' <br /> CD <br /> coo E <br /> -a R ERA/Other <br /> V A, c State <br /> o <br /> T <br /> ao R EPA/Other <br /> LU d. State <br /> t— <br /> Z <br /> LU <br /> U EPA/Other <br /> LU <br /> ZJ. Additional Descriptions For Materials Listed AboveK. Handling Codes for Wastes Listed Above <br /> O 99d20ac; 55 a. / b. <br /> c. d. <br /> Z 15, Special Handling Instructions and Additional Information <br /> Q' <br /> 7_A*.4DLEP, 'IT OS SARI, _.,A--1?-'7- <br /> Z, Apjl,, TIS` •-yrs> � �^-- ,rt, nnT- <br /> w, t <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 /> marked,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 quantity generator,I ce tify 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 /> a' 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 the 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 /> available to me and that I can afford. <br /> 0 <br /> >- Printed/Typed Name Signature' _ / Month Day Year <br /> Z <br /> Z5TR 17 Transporter 1 Acknowledgement of Rec i t of Materials /, r <br /> W p Printed/Typed� Si acute Month Day Year <br /> 7. <br /> 0 1 18. Transporter 2 Acknowledgement of Ret i t of Materials <br /> R Printed/Typed Name Signature Month Day Year <br /> NE <br /> Q R i <br /> tJ 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> 20. Focilit Owner or Operator Certification of receipt of hazardous materials covered b this manifest except as noted in Item 19 <br /> T Printed/Typed Name _ ( Signature, /• t Month Day Year <br /> t <br /> DO NOT WRI"ELOW THIS LINE. <br /> Yellow. TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC K22A (4/97) (Generators who submit hazardous waste for transport out-of-state, <br /> EPA 8700-22 <br /> produce completed copy of this copy and send to DTSC within 30 days.( <br /> MAR 2 91999 <br />