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State of Cali forma—Environmental Protection Agency <br />Form Approved OM8 No. 2050-0039 (Expires 9-30-991 See Instructions on back Of ^"9e 6. Department of Toxic Substances Control <br />Please print or type. Form designed for use on elite (12 -pitch niter. Sacramento, California <br />Y),I <br />Y)U <br />:DQ <br />7)z <br />•!O <br />V� <br />�V <br />Z_ <br />2 <br />3 <br />1- <br />Q <br />V <br />N <br />O <br />If <br />U <br />U <br />Z <br />DO NOT WRITE BELOW THIS LINE. <br />22A 1/991 Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />DTSC 80 <br />EPA 87022A To: P.O- Box 400, Sacramento, CA 95812-0400 <br />UNIFORM HAZARDOUS <br />Generator's US EPA ID No. Monis a Document No. <br />2 Page I <br />nfor..,an in the shaded areas <br />is net pertained by Federal law. <br />WASTE MANIFEST <br />J i <br />of Y <br />3. Generator's Name and Mailing Address <br />A. State Manifest Document Number <br />SAW jaifjowq COUE8:Y8 <br />22390338 <br />talk) L HAZL,ETTBT <br />B. State Generator's ID <br />STocifuY_,ET sat 4520:L iaTw .ALISON 1SODS67Sr <br />4.. Generator's Pbone 112891f468-3085 (121`.`:1958-30gf, <br />5. Transporter 1 Company Nome 6. US EPA ID Number <br />C. State Transporter's ID [Reserved] <br />D. Transporter', Phone <br />7 Transposer 't Company Nome. 8! US EPA ID Number <br />E. State Transporter', ID [Reserved.% <br />Y�GIlCJxAl SPWI t <br />F. Transporter's Phone <br />9. Designated Fr,.I I, Name and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />.. <br />H. Facility's Phone <br />BTFIlonfP ..... 56?3 <br />11. US DOT Description (including Pro Shipping Name, Hazard Class! and ID Number <br />p (i g per Aping I <br />12. Containers <br />13. Total <br />14. Unit <br />No. <br />Tye <br />Quantity <br />Wt/Val <br />I. Waste Number <br />a. pld_TY9R nFnv'SAYIDti4r"f'RIAG, 3. Intl?_53. •_. <br />State <br />LE -515:%63. (azg: 123)• (Pti M-141911; <br />612 <br />EPA/Other <br />G <br />j <br />kk <br />7 <br />e s <br />t <br />zT/a <br />E <br />N <br />b .. r dACfMlA1.. 3, UW -till t 't': r:;;. <br />state <br />E <br />_. ... s. ti e.. , <br />�{`.�� <br />812 <br />EPA/Other <br />R <br />FF <br />,� <br />- <br />L 3i <br />f <br />1 <br />r/R <br />TC. <br />State <br />0 <br />EPA/Other <br />R <br />d. <br />State <br />EPA/Other <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes for Wastes <br />Listed Above <br />+ ilA: P)i61 e+ 11R: PfCY + <br />a. <br />b. <br />d. <br />1 S. Special Handling Instructions and Additional Information <br />Bear apT,azpz a.cy P- when 4aulliry haz"'dsla acvl:.wr.. als. <br />rga StB In Elie 5K5apt. [.,Ci 60 CL^n 21i1,40,) :1) s,ZC',ti^l:ir:. Wd6^-.ft pCan ssaC3M'L apacirding t, 49 --Tl 113.121s. <br />Jtd,Y t1i33-PS090 Sa pa: 73g0S- EA ecur2�._Eas d 5, :Tcaokton,CA. :52:5 / aka eis.dn 123 <br />AANG" r^ TISFC;IF.sr S9nn)S:` err -, AP`RA P4nFFt3 {'.got;),.11:, H.231::i.1".n <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this o.m nt are fully and accurately described above by proper shipping name and are classified, pocked, <br />marked, and labeled, and are in all respects in proper condition for transport by highway according to applimble international and national government regulations. <br />generator, I certify that I have o program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br />If I am a large quanttry r <br />practicable and that 16Gave selected the practicable method of l eatment, storagerer disposal currently available tome -which minimizes the present and future threat to human healt <br />and the environment; OR, if I a mall quantity generator, 1 have made atgoad faith effort twminimize my Wo !"rt)oeraiion an%elect the best waste management anageent method that is <br />mush <br />available tome and that Lean afford. - -- �� - - <br />Printed N me `r� <br />Signature ) /7i '`): Gam', <br />_ You, <br />ii� <br />1L <br />T <br />17, Transporter 1 Acknow led amort of Receipt of Materials .^''1 •« <br />R <br />Prints �.¢p d 7 <br />Signature; <br />py:a ear . <br />_J <br />5as <br />re <br />0 <br />18. Trans orter2 owled ement of Recei faF Materials <br />n <br />R <br />Printed/Typed Name <br />Signature % <br />Month Day Vear <br />E <br />R <br />f <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />1 <br />20. Fed ityOwner or Operator Certification of receipt of hazardous materials <br />covered by this manifest except as noted in Item 19. <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />Y <br />DO NOT WRITE BELOW THIS LINE. <br />22A 1/991 Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />DTSC 80 <br />EPA 87022A To: P.O- Box 400, Sacramento, CA 95812-0400 <br />