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ate of California—Env,a menml Protection A <br /># genes <br />.,in A SAP pt'wed.OMB No. 2050-0039 (Expires 9-30-991 <br />SPI I i or type. Form designed Foruse on elite 112 -pitch) <br />7 <br />t <br />C <br />a <br />UNIFORM HAZARDOUS <br />a <br />See Instructions on back of r-qe 6. Department of Toxic Substances Control <br />ikr. S 16 <br />DO NOT WRITE BELOW THIS LINE. <br />Yellow: TSDE SENDS THI5 COPY TO:GENERATOR WITHIN 30 DAYS. <br />DISC 8022A (1/99) - (Generators who submit hazardous waste for transport out-of-state, <br />EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />_ <br />1 .motor's US EPA ID No. Manifest Document No. <br />acramento, Ca i me <br />2. Page 1 Information in theyyhad areas <br />WASTE MANIFEST <br />is me r d Cye/y�t1glIt. <br />21 7 <br />of `(-,' <br />3, Generator's Name and Mailing Address <br />A. Stale Manifest Document Number <br />22390339 <br />> <br />1910 a HALSIR'TON <br />B. State Generator's ID <br />Tqk31584 <br />4. trIron A'TTO.A: ALT80I3 H'Qi'4)$027 <br />�AqD. <br />5'. Transparler I Company Nome 6. U EPA ID Num er <br />C. Stale Tronsporter',, O [Reserve i j <br />TransporleYs Phoria <br />> <br />7. Transporter 2 Company Name i U EP ID um er <br />E Slate Traniporrer's ID [Reierved.j - <br />( <br />F. Tronsporea's Phone <br />/ <br />9. Designated otitis Nome on Site A rens 10. U EPA ID Number <br />G. 5t IF IIIIF <br />, 1.111 (2 <br />- <br />9!rcis TPi..1�41nQtau <br />1.787 8- U=72 STRK" <br />H. Foci i s Phone <br />'K17 a mO"I ® 99714 <br />t <br />11. USDOT Description (includingProper Shipping Name, Hazard Class, and ID Number) 2. conine's <br />3ata Id. Unu <br />No, <br />Tye Quantity Wt/Vol I. Waste Number <br />a. EL712113eeLE LI QUMS, W,O, S„ 3, IM493, F IIr, <br />—_ <br />State <br />{ ealiesei, rx Fipeexey , C 3s 138) , (Pf: 7447li <br />EPA/Other <br />ii <br />E <br />t N <br />b' <br />State - <br />E <br />R <br />EPA/other <br />A <br />T <br />` <br />stare <br />O <br />EPA/Other, <br />R <br />d. <br />Stale <br />EPA/Other . <br />1. Additional Descriptions for Malerielz Listed Above' - <br />K. Handling Codes For Wastes Listed Above <br />31iA3 ?4475Cs x. -_ <br />I <br />b _. <br />15. Special Handling Instructions and Additional Information <br />i - -Pailm opriaC.ss TMF, eshs, heanaxtuly haxandrnze uatari.ala. <br />V`I ie gtaee- stampt pvst 40 OTA5.i .4(b) (1) ezalueSom. Waata sane paekai aooncrding, to 49 OF'n. 17A3 121, Jcr1Y <br />1483- <br />E@or+s3ssnay aoxstcaotr R-1-11104 LEE tfrer" NAC (R00?535-5053 WMR T'EM1Pm [Pn0^E4C.PIsle EXrII1WA&'P1"C ('3PE'.$SCf1E2T s.L4RSDLIg <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignmenlare fullya d accurately described above byp per shipping name and are classified,pocked, <br />marked, and labeled, and are in .I1 respects in proper condition for transport highway according a app cable international <br />y and national government regulations. <br />If I am a large quantity generator, I certify that I have p m in place to reduce the volume and roxxcjp;,o6wazta y aced to the degree I have determined m 6e tori. is IIy <br />Prcable cab) d that I haveselected the pp m <br />imoica6le ethodrof t tment storage; or disposal currently available to me whirl jefrimizes the present and future threat to human health <br />and the environment;OR, if I am a malI quantity generator, I have made is �ff t t ize my w stems a�an and select the hest waste management method that is <br />ova table to me and that I c a afford. f - - <br />Printed yped N is <br />signature s1. `''f .� y <br />Month Day Year <br />I <br />77. Trans or er 1 Acknowledgement of Recei t of Materials <br />APrinted/ <br />R <br />Nome <br />Si natur <br />9 `-- <br />a th Doy ear <br />P <br />a <br />18. Trans ort r 2 Acknowled emenl of Re<ei f of Malarial: <br />M <br />Prints <br />Sig 1 <br />19. Di,r,rjj,c, Indication Space <br />A <br />g a l �9 w�irA,,.+' <br />( <br />1 <br />acipi i Owner or O era <br />er Certification of receipt of hazardous materials cover anifest ex t as nbudin it.. 19: <br />T <br />ri i <br />/ sped Na <br />L <br />s1. otvre '� <br />Ifpnt Day Year <br />(j. }(e <br />z� <br />DO NOT WRITE BELOW THIS LINE. <br />Yellow: TSDE SENDS THI5 COPY TO:GENERATOR WITHIN 30 DAYS. <br />DISC 8022A (1/99) - (Generators who submit hazardous waste for transport out-of-state, <br />EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />