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Stafe 6Ca1iforoia—Environmenta1 Protection Agency <br />From Approved OMB No. 2050-0039 (Expires 9-30-99) See Instructions on back of nnqe 6. Department of Toxic Substances Control <br />Please print or type. Form designed far use oa elite (12 -pitch) iter. Sacramento, California <br />C <br />C, <br />DO NOT WRITE BELOW THIS LINE. <br />DISC 8022A (1/99) <br />EPA 6700-22 <br />Yellow: GENERATOR RETAINS <br />. s'enerator's US EPA ID No. Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />UNIFORM HAZARDOUS711 <br />is not required by Federal low. <br />WASTE MANIFESTAH <br />113.111010101310141 1 S 6 <br />al <br />3. Generator's Name and Mailing Address R" 30AWXR mear: <br />A. State Manifest Document Number 22390372 <br />LOVUL M ata. x810 it. )1Aars <br />223,2233ytLt�Oi/dRSM RAAD STOCK'SO)), CA 93201 <br />B. State Generator's ID <br />4"-�neroFoN3 Phoma AT"T7 t0MMRA AMR%*' <br />�O4 9J2 -b976 12d4 4 <br />S. Transporter 1 Company Name 6. US EPA ID Number <br />C. 51ate Transporter's ID [Reserved.) <br />D. Transporters Phone PSM1792 SODS <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Trahspodeds ID [Reserved.] <br />F. Transporter', Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. state Facility's ID " <br />03' <br />H. Facility's Phone <br />9TDG7C+OH t79 43206 <br />C I Alx 1 1.1 11 11 01 01 t o <br />(204)466-3670 <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12- Containers <br />13. Tolol <br />Quantity <br />14. Unit <br />Wt/Val <br />I. Waste Number <br />No. <br />Type <br />ri (ALCOISOL,PATAOLVU%! DISTILLATES) . ( + 128) , (R£v�� <br />State 1111hA <br />G <br />T44520) <br />�j <br />D <br />-�•^1 <br />sty i/ <br />p <br />EPA/Other M <br />E6 <br />Stale Wt <br />E <br />137), (Pg* 744521) <br />EPA/Other N <br />R <br />y <br />D <br />R <br />go <br />A <br /><' li; Ii. (nChlor'rdiR9. Pa G2^,191114'DlaY111ACGa) , (6Laf <br />T f, <br />SNIP <br />la <br />R <br />131), (pEr 744522) <br />z�) <"t t <br />ly• <br />7� O <br />It <br />EPA/Other Im <br />a 7t <br />(J V <br />cl <br />d -7x• (ispjlgg5), (8x3: 164), (p£: 744525) <br />State to <br />�! <br />0 0 1 <br />D <br />L7� / <br />{Wastes <br />R <br />EPA/other 144 <br />J. +Addkanal'D44SQOorh4or7NffiTeria7 AlA9e` 11Cs 744522 ei LID, 744525 + <br />K. Hand g Codes for <br />Listed Above <br />a. <br />6. <br />II <br />ms's <br />d. <br />1yey�P[iB�yB�i(1f[fi�}%a VtWtl'Y�YIaT+r3T+T;tL98 i:aLd Wi6 ausceselila.TT99LeilR W11= ..?t Psi 40 c -m lksiar apple p .ae, <br />PW, N)f Jtl num,113'!AQ Rt14A r]arm1)JY 1)9E 4n CPR <br />jY1 <br />361. 4(b) (1) vrol%teams. ira.stq was paafeed acwacdizstr to 49 CER 773. W -b. Job! 1403-- 06575 <br />d <br />Ireeer7essay CQw.tAcc, .T7FD0(( 4111min (209)468-6670 NEAR PPDMR Famr % 1TV'T PJar11lsl@3PP (p¢P)SERW fLuzor'11PCi <br />;{ <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurate)yy desi,66eda6ove byp per shippingname and ore classified, pocked, <br />marked, and lo6eled, and are in oil respects in proper condition for transport by highway according to applicoble internationol and notional government regulations. <br />'141 <br />! <br />If am a large quanlih generator, I certify that I have a pr gr m in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economical) <br />! pnctlmbla and that I have selected the practicable method of treatment, storage, disposal curally available to me which minimizes the present and future threat to human heoit�, <br />If the environment; OR, it am o small quantity generator, I have made a goo (with' (fort gm"lnlmae my waste generation and select the best waste management method that is <br />1 <br />ov,; Iablc 10 me and that I afford. , <br />e.P <br />P to /ITypedlNo c s .f< .f th", <br />Si no Y /f' <br />Monty, Day Year <br />' <br />U(� c <br />17 Transporter I Asia owled ent of Receipt of Materials <br />,; <br />P nl <br />/Typed Np _ <br />Sign a 9 j <br />Year <br />onl 13a <br />�d <br />J <br />11 <br />n <br />18. Transporter 2 Acknowled ement of Receipt of Materials <br />R <br />Printed/Typed NameSignature <br />Month Day Year <br />II <br />4 <br />19. Discrepancy Indication Space <br />A <br />C <br />I <br />I <br />20. F.city Owner ar Onembr Certification of receipt oPhozordoes materials <br />covered by this manifest except as noted in Item 19. <br />T <br />Primed/'typed Name <br />Signature <br />Month Day Year <br />Y <br />DO NOT WRITE BELOW THIS LINE. <br />DISC 8022A (1/99) <br />EPA 6700-22 <br />Yellow: GENERATOR RETAINS <br />