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-". <br />�Sidfe bFColifornia aEnvironmenml Protection Agency <br />Farm Approved 01 No.2050-0039(Expires 9-30-99) See Instructions on back of pine 6. Department of Tcocsab,mn... Contra) <br />Please print or lype� Form designed for use on elite (12pitch)h kr. <br />Ii <br />DO NOT WRITE BELOW THIS LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS.. <br />DTIC 8022A (1/99) (Generators who submit hazardous waste for transport out -of -stale, <br />EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.f <br />UNIFORM HAZARDOUS <br />eralor's US EPA ID No. Manifest Document No. <br />Sacramento, Camornm <br />2 Page 1 <br />Information in the shaded areas <br />WASTE MANIFEST <br />t{not Fedr}al low. <br />3 9 <br />of 1 <br />q9,! <br />'[7�Sj`b''' I <br />3. Generator's Name and Mailing Address <br />A. Slate Manifest Document Nummbberi <br />MW <br />223901 r�. <br />1810 E 1� <br />B. State Gmmaafor's ID <br />I <br />I <br />s 45291 a Wsaa Ifflawav <br />4. Genererois PRone204)9tiS8-3086 <br />(209)658-30B9C <br />v <br />0 <br />5. Transporter 1 Company Nome b. US EPA ID Number <br />C. State Transporter's ID [Reserved.) <br />NIMS TAMC 2 <br />D. Transporters Phone <br />7, Transporter 2 Company Nome 8. US EPA ID Number <br />(9701863-1173 <br />E Slate Transporter's to [Reserved.) <br />( <br />7 <br />Smith arattsmiuli TKapapaxt 2 <br />F. Transporters Phone (800) 884-284 <br />( <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State fv� li 1 1. ( + 1 ! t r <br />On "1 —T O•/ <br />%toxis wilmir4ton <br />( <br />- <br />1737 S. lYzlPI 32AtEY <br />H. Facility's Phone <br />"XIMINMM, Ea 90714 <br />- <br />-I d 4 4 4 4 <br />910 838-0778 <br />( <br />1 <br />11, US DOT Description (including Proper Shipping Nome, Hazard Class, and ID Number <br />pion lint g pe pp"ng I <br />12. Containers <br />13. Total <br />14. Unit <br />No. <br />Type <br />Quantity <br />Wt/Vol <br />I. Waste Number <br />1rLAb11,08.EM LIQUIDS, V.O.S_ 3, trn1993, Re TI, <br />- <br />(3aaaliess, tlli t ca), (ocgi: I28J, (pf: 744756) <br />State <br />Su <br />. E <br />7 ' J <br />A M <br />O C 1713, <br />7NM <br />p <br />EPA/Other <br />i <br />s N <br />b. <br />State <br />i E <br />R <br />EPA/Other <br />A <br />1 T <br />` <br />sane <br />i O <br />- R <br />EPA/Other <br />d. <br />1 <br />Stare <br />i <br />t <br />i <br />EPA/Other <br />1. Add'fonol De�q 0ns for Materials Listed Above <br />t {�pc 74 M ♦ <br />K. Handling Codes For Wastes Listed Above <br />15. Special Handling Instructions and Additional Information <br />Wesas: appcepci.eko p2E .hon handlirsg hazasdaue soa Caziala.TMeGnie PG'R§ ovmsgsk nx 40 CEA / yW Guide, 128 <br />t^ntesirja¢scry Cant FllsH y7 LEY.' TXFsgYD%hC (300)5.35-8059 WVAR ? OJVIRR PPDTM-rTYE Mu rpkAWT (1?T+R;)WHE8 "DWEILINEI <br />T6. GENERATOR'S CERTIFICATION: I hereby declare [hat the contents of this consig ment are fully and occurately described above. by proper shipping name and are classified, packed, <br />marked, and labeled, and are in all respects in proper condition for transport Icy highway according 1e, applicable international and national government regulations. <br />II I am a large q anti" generate," I certify that I have proggram in place to reduce the volume and exic% f waste generated to the degree I have determined to be economically <br />practicable and that I have elected the treatment, disposal <br />sI <br />proctico6le method aF storage, o currently available to me which minimizes the present and future threat to human health <br />and the env ronm t, OR, ifa a small quantity generator, I have made a good faith effort to a my waste generation and select the best waste monagemant method that is <br />available tome and that can afford <br />Prinnttw TTy�pe�dJN�oAmee C',,7 Fy (SN <br />Si not. <br />,/Month <br />("y Ui/ <br />(f <br />T <br />R <br />17. Transporter I Acknowledgement of Receipt of Materials - <br />R <br />Prinle TpNryE S <br />g <br />Mon 7Day? Vee <br />r pPGv',`pV1e- <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />T <br />P - /Typed Name <br />Sign <br />Month Day Year <br />E <br />R <br />. Dis r panty Indication Space , - <br />F <br />A <br />C <br />I <br />L <br />20. Focili Owner or Operator Certification of racer t of hazardous materials <br />covered b this maddest except as noted in II 9. <br />Y <br />P^YP dr� <br />Signa <br />_nth �ay <br />U V <br />DO NOT WRITE BELOW THIS LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS.. <br />DTIC 8022A (1/99) (Generators who submit hazardous waste for transport out -of -stale, <br />EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.f <br />