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State of California—Environmental Protection Agency
<br />Form Approved OMB No. 2050-00391Expires 9-30-99)
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<br />See Instructions on back of pone 6. Department of Toxic 5ubstances Control
<br />S^ t C lit '
<br />cromen a, o life
<br />DO NOT WRITE BELOW THIS LINE.
<br />DTSC 8022A (1/99) Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS.
<br />EPA 8700-22 To: P.O. Box 400, SacrameNa, CA 958120400
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<br />UNIFORM HAZARDOUS
<br />'rotor's US EPA ID Na. Manifest Document No.
<br />2 Page 1
<br />Information in the shaded areas
<br />WASTE MANIFEST
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<br />s not required by Federal law.
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<br />3. Generator's Name and Mailing Address Sm •70AQUIN cou"y
<br />A. Slate Manifest Document No. er
<br />kalux A'Y X44 3eilEi15F23:L 1810 11. MAL6TNM
<br />22390101
<br />:1120 was xitimar is STOCIali tat 9520e
<br />S Slate Generator's ID
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<br />13DI, d- c 45246 76VW AIImui gs5n?awlif
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<br />A. Generator's Phg1T04y86'J_9858 {209)458-9068
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<br />5. Transporter I Company Name 6. US EPA ID Number
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<br />C State Trans t s Reserved
<br />Por er ID (_ ]
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<br />TdRxS LLC(670)669-7175
<br />D. Transporter Phone
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<br />7. Transporter 2 Company Nome 8. US EPA ID Number
<br />E. State Transparter's ID [Reserved.]
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<br />F. Transport.( s Phone
<br />Y. Designated Facility Name and Site Address 10, US EPA ID Number
<br />G. Slate Facility's ID
<br />San aoarrznan PIEwar
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<br />7650 S. RR OF -MD --.W R5RC1 -
<br />H- Faciliys Phone
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<br />STOCTa<CTM, C1, 95206
<br />209)458-5670
<br />11. US DOT Description (including Proper Ski Name, Hazard Class, and ID Number
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<br />12. Contoiners
<br />I3. Total
<br />14. Unit
<br />No.
<br />Type
<br />Quantity
<br />Wt/Vol
<br />I. Waste Number
<br />dRSFt.?+B1E LIQUIDS. N. D. S. 3, 1=993, PO T7
<br />T-al-gnak), (azg. '2R). 1pf: 79452(1)
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<br />CST
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<br />144521)
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<br />EPA/Other
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<br />&AL*5TT0 ALFJ%I-.i yS{IUIOS, 9.0.5 , 8, V111719. s- Ti.
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<br />lists �aok}. (erq: 1.54<pf: 744525)
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<br />�. 1 ditlogQ14D4$,s�rti�is f�riSMate(1r�ls4�it1.d RovpSC: 744422 *e 110s 744525 a
<br />K. Handling Codes for Wastes Listed A6ove
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<br />15. Special Handling Inslro<8ons and Additional Information
<br />Yreae. npprespriatx ELxi; ssluxs Y.an3_ng hnzardaus matror:tai s.'R3eLer15 PC1EA a Y901aT0.4U 47M 4i9mt apE`rOprJ.Atm
<br />PT-xn p}1,]i] tt9nr^.1.1IkJ 4a'l.AASt1O1.Sa ILLAi:HT\615. NdIfi 1619 SCPA neavrtic );-3L QD ..PR.
<br />2fi] "Flat (1) ,axulszaion. Mseat+s ®as y;auked dot-nzdi._•wy to 49 CM 173.12b. 3csbtl .1983- 06369
<br />Lbsssgusoyr Contaeet: ,n+lilEti RAUT; (209) 46R-5670 WM* . PRORM PP=N=TVC s'.XAI_�+$'FT {?P'uT4 W:-fy'rys' F132cZ`1.T.T•'
<br />16. GENERATOR's CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by p per shipping name and are classified, packed,
<br />marked, and labeled, and are in all respects in proper condition for transport by highway to
<br />according applicable international and notional government regulations.
<br />If I am a a lar onl'
<br />g q generator, I certify that I have p .gram in place to reduce the. volume and toxicity generated ro the degree have determined m 6e
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<br />ewaste economically
<br />eradicable and that elected the practicable method of treatment, storage, disposal currently available me which future
<br />minimizes the present and thenal ro human heo6h
<br />and the environment; have
<br />if am a small quantity generorop have made a good faith effort m minimize my wash generation and select the best waste management method Ihat is
<br />waste
<br />avoila6le to me and that I can alfard.
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<br />d/Typed Name r, .rC ,,-Pk f\t"%
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<br />Signaro I/i V/
<br />Month Day Year
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<br />17. Trans orter I Acknowled errant of Recei I of Materials
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<br />Printf % YPed N m .,
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<br />Month Day Yea.
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<br />Transporter 2 Acknowledgement of Retei t of Materials /
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<br />Printed/Typed Nome s
<br />Signa Nee
<br />Month Day Year
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<br />19. Discreponcylndreolion Space
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<br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19.
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<br />Primed/Typed Name
<br />Sgne,Wre
<br />Month Day Year
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<br />DO NOT WRITE BELOW THIS LINE.
<br />DTSC 8022A (1/99) Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS.
<br />EPA 8700-22 To: P.O. Box 400, SacrameNa, CA 958120400
<br />
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