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<br />Stale of Odiforn is—Envi ran mental Protection Agency
<br />Form Approved OMB No. 2050-0039 (Expires 9-30-99) See Instructions on back O{}' --e 6, Department of Toxic Substances Control
<br />Please print or type. Farm designed For use oa elite (12-p;tch) ry -or, S 1 C life
<br />DO NOT WRITE BELOW THIS LINE.
<br />DTSC 8022A (1/99) Blue: GENERATOR SENDS THIS COPY TO DT5C WITHIN 30 DAYS,
<br />EPA 8700-22 To: P.O. Be. 400, Sacramento, CA 95812-0400
<br />acramen o, o ormo
<br />UNIFORM HAZARDOUS
<br />1. ,-- m-ra is US EPA ID No. Manifest Document No.
<br />2. Page 1
<br />Information in the shaded areas
<br />WASTE MANIFEST
<br />is at required 6, Federal law.
<br />1 2 1 4 T
<br />a(2
<br />3. Generators Name and Mailing Address 5,", ' M co
<br />A. Slate Manifest Document Number
<br />LOVIMMM ;asoma. 1910 M. AASm
<br />RLJ
<br />2 3 9 0 3 5 8
<br />2323 Lovzt MOAT) STOCKMM r ,Ch 95201
<br />B- Slate Generalo/s ID
<br />�Acs
<br />M G r'r'e Ph AT T: KUWRA MWR KS
<br />:269mi-5779 (209)469-3065
<br />5. Transporter 1 Company Nome 6. US EPA ID Number
<br />C. Slate Transporter's ID )Reserved.1
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<br />TSR3(S LLC1870)R63
<br />'D. Tmnsporter's Phone
<br />7. Transporter 2 Company Name 8. US EPA ID Number
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<br />2173
<br />E. State Transporter's ID Reserved.
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<br />F. Transporter', Phone
<br />9. Designated Facility Name and Site Address 10. US EPA ID Number
<br />G. State Facility's ID
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<br />5an lonquin FFWCW
<br />79$0 8. RA 9RIDP3MTOW,
<br />H. FJITy's Phone
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<br />S , G71 95£05
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<br />1I. US DOT Description ncludin Pro Shipping Name, Hazard Class, and ID Num6sr)
<br />p li g per pp'ng
<br />12. Cc-toine
<br />13. Total
<br />14. Unit
<br />No.
<br />Type
<br />Quantity
<br />Wt/Vol
<br />I. Waste Number
<br />(lab -pack}. :ergo E28g. (p£; 7$45X)
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<br />131), (pt: 744522)
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<br />K. Handling Codes for Wastes Listed Above
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<br />c.
<br />d.
<br />15. Special Handling Instructions and Additional Information
<br />tsar appzopr>ata PPL than handling haaardexse matesrxal..aaetas.. Etc= exempt 40 CFa ,deans
<br />Pus appropriates
<br />PPC` who± i:and)ing hazardaae mntewinls. Xastais RCRts ^.szze40fpt pas 40 CFR
<br />261-4 (h) (1) +>xalcuim, wheat% sas paa7sad mooar3.ng tp 49 CBA 173,121M. .labs 1483- 0636,
<br />^.ss¢.rgax:ay Contact: XIFFE" PALM (209)468-5670 x1FAP. RWApm PPDTLCTllT x�CST.'IFMFaT (1?L+E)HPIHT EiRI�'tY,.^3.'3
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<br />16. GENERATORS CERTIFICATION: I hereby declare that the contents of this conig enl are fully and accwotaly described above by proper shipping name and are classified, packed,
<br />marked, and labeled, in in
<br />and ore all respects proper condition for transport by highway according to applicoble international and national government regulalions.
<br />If 1 am a Imge quant;q generator, edify that I have o proggr m in place to reduce the volume and toxicity F waste generated to the degree I have determined to 6e cenomically
<br />practicable and that have selected the treatment, disposal
<br />proctica6le method of smroge, or cur enlly avails le to me which minimizes the present and future threat to human heahh
<br />and the environment; OR, if I am a smell quantity generator, I have made a good Fo (6 Oforl t mini e y ante neratian and select the best waste management method shot is
<br />available ta me an thm I can afford. ,
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<br />Prinrid Typed Nome r i t. .L:) /
<br />ti f rf /t/ L,, �cerJ ar7/9G7(i��
<br />Sig ,lure / �
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<br />Me Dvy Year
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<br />17. Transporter 1 Acknowled 1 ent of Receipt of Materials
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<br />Printed Typed Nom,S t � Signet / '"' �
<br />- ,{ f r (1 tr K / Montly, Day Year
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<br />`� 71 12-1 KIL6i
<br />18. Tree. or ter 2 Ackee,vlyd a err el Recei t of Mmedels ,
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<br />Printed/Typed Name
<br />'Signature
<br />Month Day Year
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<br />19. Discrepancy Indication Space
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<br />1
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<br />1
<br />20. Facility Owner orOperator Certification ofreceipt of hazardous materials
<br />covered by this manifest except as noted in Item 19.
<br />T
<br />Prinled/Typed Name
<br />Signature
<br />Month Day you,
<br />Y
<br />DO NOT WRITE BELOW THIS LINE.
<br />DTSC 8022A (1/99) Blue: GENERATOR SENDS THIS COPY TO DT5C WITHIN 30 DAYS,
<br />EPA 8700-22 To: P.O. Be. 400, Sacramento, CA 95812-0400
<br />
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