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State of C.I F.mia—Environmental Protection Agency <br />Form Approved Oft No. 2050-0039 (Expires 9-30-99) <br />Please printer type. Form designed for use on elite 02 -pitch) typ...,der. <br />See Instructions on back of , 6. Department of Taxle Subetonces Control <br />Sacramento. California <br />DO NOT WRITE BELOW THIS LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />DTSC 8022A (1/99) (Generators who submit hazardoas waste far transport out -of -stale, <br />EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page I Information in the shaded areas <br />7 3 is note �db�Fld,1lay, <br />WASTE MANIFESTclAll-ij <br />y of <br />11 111101 <br />3. Generator's Name and Mailing Address A. Slate Manifest Document Number <br />rw� <br />1:vi3N1f1t 'Oe dulls JQA(?Q1N / <br />qq <br />:M 1ki S. ''thZEL:'Oti 7'i I1'ord ouB50a B. State Generator's ID <br />5iVGk."VN t, ;+Sid' '1 N' <br />4. Ganeraror's 9hon � ost 41i¢s-scaa ( N dab <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. Slate Transporter', ID [Reserved.j <br />1'e r•>, B. L.i.4. T E. J <br />D.. Transporter's Phone <br />0 U 9 _ d p ;i <br />` <br />_ rn <br />7. Tr7��rier 2 Com y Name 8. US EPA ID Number <br />IJ'/1a�SYGwt^,+C. L <br />d <br />E. Stale. Transponer's ID [Reserved.] <br />71C1i{b v F_ A 1 tto <br />---oh -Tr -'j �p -7•'"1 <br />F. <br />F. Transportar's Phone <br />pgq•g--1>' 0 t -• -g' •� s <br />twoy-'&g"— vq- <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />T R tS <br />G. Stale(( cility's ID �((� <br />r <br />ri/'44 L-I <br />H Facility Ph e <br />i 7 G/ ';,` <br />y'ri <br />fiJ 7U IJ, C 907(14 4 g ,, a 4 p, _ _ <br />53 1 053 5-U7? <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number <br />p I' g pe ppi g I <br />12. Conjoiners <br />13. Total <br />14. Unit <br />No. <br />Type <br />Quantity <br />WI/Vol <br />I. Waste Number <br />o. ' 1; _eo 29 Z2. (Dp'C-8 Rk1624) Cerg: <br />Slate <br />128) , [pt: ai:;:4d6T• <br />( <br />f <br />7�oQ7y <br />4^ <br />E.. <br />003 <br />s t <br />N <br />b , ;za: <br />state <br />R(7'-x'/"!5'7} <br />EPALLpp��ha11N, rs, <br />011 H <br />�, <br />r. <br />01 <br />T <br />c. ...... , R i<,": ,. <br />Ro .x to®.s:a-tiaata <br />State <br />R <br />s. t' 4• t/; 'v <br />v O I <br />U O 3 0 0 <br />EPA/Otber <br />a <br />st <br />EPA/Other <br />J Addomaal De_IFsarl tions for Materials Listed Above / <br />K. Ma ng CV.s for Wastes Listed Above <br />'�1� <br />lS.A: (�#rti' ) ** 135: T.447r'E9• [ Isf%SS ) ** 3iC; {F.XP <br />� � e <br />a b r1c, a— <br />15. Special Handling Instructions and Additional Information <br />Job # 14883-04d11 :lite :?950 S. RA Br:idgefoce 9t.Gtocktoa,Da <br />vaete is xcaR a;xe:sRst pe= d0 CPPB 2E1 .: fb1 (1) e'sc2 usion_ nse prop a. B%tJ; when bAnd).Szag hazardous <br />risen or ;aa. ! Edr; aaine !..., _- <br />err•ar,- s ss <br />Ib. GENERATOR'S CERTIFICATION: Thereby declare that the contents of this cansigY mens are fullya daccurataly described above byp per shippngna and are dassiFied, packed, <br />marked, and labeled, and are in all respects in proper condition For transport by highway according to applicable international and national government ragolations. <br />If I am a large gaanli generator, I certify that I have a proggram in place to reduce Ilse volume and toxicity of waste generated in the degree I have determined to be economica11 <br />that I have the treatment, disposal to future human health <br />practicable and s elected practicable method of storage, or currently available me which minimizes the present and ea <br />re thrt to <br />and the environment; OR, if) am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br />ovoila61e tome and that I can afford. <br />Printed/Typed Nome <br />Signature y -Toth <br />oDay Year <br />.' <br />ly <br />T <br />I .Trans anar 1 Acknowled a ant of Rei t of Materials <br />pPrinted/Typed <br />Name A <br />Signature <br />Month Day Year <br />F <br />ti� <br />�- <br />8 <br />I8. Trans oder 2 Acknowled ement of R ei t of Materials <br />T <br />Printed/Typed Name /j <br />Signabre C <br />Month Day ear <br />R <br />/+Y <br />19. Discrepancy In (cation Space <br />F <br />A <br />C <br />I <br />1 <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered hy this manifest ex&t as,hotel in [tea 9. <br />T <br />Y <br />Printed/T p Name <br />�li�. �LL <br />Signature <br />^ / <br />yj p�D°y) <br />F��` <br />�r�/ <br />�/ C.r <br />DO NOT WRITE BELOW THIS LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />DTSC 8022A (1/99) (Generators who submit hazardoas waste far transport out -of -stale, <br />EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />