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Stale of California -En vireemenal Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9-30-991 <br />Please print or type. Form designed (br use on elite (72 -pitch] ypi <br />See Instructions on back of pa -- .6. Department of Toxic 5ubstancesControl <br />DO NOT WRITE BELOW THIS LINE. <br />DISC 8022A 11/991 Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />EPA 8700-22 To: P.O. Box 400, Sacramento, CA. 95812-0400 <br />UNIFORM HAZARDOUS 1. Ge..: color's US EPA ID No.ULLL� Manifest Document No. 2. Page I Information in the shaded areas <br />WASTE MANIFEST ( 1 2 1 4 $ of is nal required by Federal low. <br />Geiser Name <br />Generator's Nome and Mailing Address �` A. State Manifest Document Number <br />13. <br />1 Zs's <br />3616 E. P(21E$Tssi'ON <br />17726 ROAST 1EARNE7 in S?lOCXTQBT, Ca 952151 O 364 <br />LMS, {d 992246 ATTP'Y.AMRA AEFDRB(R9 B. Stale Generator's ID <br />A. Generator's Phaq?9)687-SafiB (2154)458-366fi <br />5. Transporter 1 Company Name 6, US EPA ID Number <br />C Slate Tronsporter's ID IReserved.1 <br />'FB.R.23 LIC <br />D. Transporter', Phone (870)66'-737$ <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporters ID Reserved.] <br />F. Transporter's Phone { ) - <br />9. Designated Facility Name and Site Address 10. US EPA ID Num6er <br />San ,�oarduAlm Fe"Cr <br />G. State facility's ID <br />g856 S. FA RRM30T0011ILD <br />H. Facility's Phone <br />9im"emall. GA 9FS266 <br />if Ill. IL E P 14 11 111 14 4 <br />{369)468-5476 <br />11. US DOT Description (including Pro Shipping Name, Hazard Class, and ID Number <br />pI g per pp g I124 <br />12. ContainersP13.Tol.l14. <br />Unit <br />No. <br />TypeWI/Val <br />I. Waste Number <br />a( .a'177 ao)e) , (azg: 129) . (pf7445201 <br />StateG <br />�) (%2. <br />F <br />EPA/Other7�N <br />h, T-;-(;Trva£iza,;-+ r-da3hcaw si•r-l'�'3:-7-g3#-+-{£'Eu <br />State 612 <br />E <br />7405217R <br />EPA/Other IRA. <br />4@ <br />%+Y_l::'1. ? ', (1eyxstksr;].F!8,-r?LLorlanel. 2•=-g- <br />�1aezLy <br />State 61.2 <br />O <br />.oil , ,'.: r.: <br />EST <br />EPA/Other;i <br />R <br />' <br />T <br />L L ,( <br />�. - ';:K:. {arty: t54)(12f:7445257 <br />tvl <br />Slate 6122(� <br />� <br />IF <br />� ����EPA/Other <br />}. 744822 e• 11a: 744525 * <br />K- Handling Codes for Wastes Listed Above <br />a. b. <br />d. <br />sus a pp�z>fsr9.�I@psi+± FssnEl�d�i lZtt81.�('H/j1ni,Iii atarnxs mxtu 11> 15.F!a®Gals RMA examptt Lxic 40 CPR Wear appz•oprrein <br />PpF Fnc'rasxdlirq ha Tartfsver 1➢i9 tALiA1A. W3Etd,.O HA.Vr. p%T 4lt CFit <br />(L7 cexn-fusion. Warta ram pace l +eeoecds.rsg t-1 43 [:PR. i 73. 12b. .1obK i 483- 06369 <br />Tar gnmcy rent:acst- .Tt1S3AN RAxfD (209) 4e8 -5±i 70 xL.YR Ring - TnRarff; PTV BnTx YT1,112RP 4t>FE)3+2'P3: H m -LL iza. <br />16. GENERATOR'S CERTIFICATION: 1 hereby declare that Ile contents of this contig mentare fully and accurate)y described above by proper shipping name and are classified, packed, <br />marked, and labeled, and are in all respects in proper condition for transport 6y highway according to applicable international and national government regulations. <br />If I am a large quantiq generator, I certify that I have a proggram in place to reduce the volume and toxicity I waste generated to the degree I have determined to be conn "ally <br />practicable and that hove selected the procticable method of treatment, storage, or disposal currently a aRoble to me which minimizes the present and future threat to human health <br />and the environment; OR, if I am a small quantity generator, I have mode a good faith effort to minimize my waste generation and select the best waste management method that is <br />voilable to me and that I can afford. <br />Prinked/Typed Np'me <br />"r7y: +°r6_u� <br />Signayes-year <br />1.=rr <br />Llf <br />= uJ`/LFr n i _ ''e-rry `e <br />7� ✓��� f .E,yk',./y <br />j7 <br />F <br />A <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />A <br />Printed/typed N me n ! r--- <br />S�n ( r - <br />M Ih•, Day Year <br />S <br />771P <br />R <br />18. Transporter 2 Acknowledgement of Receipt of Materials • i <br />RPrinted/T <br />T <br />yped Name <br />�5 g�ature <br />Montt Doy Yeor <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />1 <br />20. Facility Owner or Operator Certification of recei t of hazardous materials <br />covered by this manifest except as noted in gem 19. <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />Y <br />DO NOT WRITE BELOW THIS LINE. <br />DISC 8022A 11/991 Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />EPA 8700-22 To: P.O. Box 400, Sacramento, CA. 95812-0400 <br />