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State of California -Environmental Protection Agency <br />Foran Approved OMB No. 2050-0039 (Expires 9-30-991 See Instructions on back of e 6. Department of Toxic Substances Control <br />Please print or type. Form designed for use on elite (12 -pitch) rifer. Sacramento. Crshfnrnlr <br />C <br />n <br />v <br />OF <br />C <br />C <br />r)a <br />Qk- <br />9):5 9)Z <br />10c, <br />�C <br />Va <br />U <br />Z <br />x <br />3 <br />c <br />m <br />m <br />V <br />r <br />V <br />O <br />00 <br />rs <br />1- <br />Z <br />w <br />U <br />w <br />N <br />O <br />N <br />assZZ <br />O <br />ZZ <br />S <br />t- <br />U <br />Cs- <br />`4 <br />asoO <br />U <br />Z <br />W <br />f <br />w <br />C <br />N <br />U <br />U <br />r <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A 1/991 Blue. GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />EPA 8700-22 To: P.O. Be. 400, Sacramento, CA 95812-0400 <br />UNIFORM HAZARDOUS <br />1 Generator's US EPA ID No, Manifest Document No. <br />2. Pagel] <br />Information in the shaded areas <br />is not required by Federal law. <br />WASTE MANIFEST <br />C t.' <br />f; A H i. 1 t) U o �' j 9' R -1, .ly 5` <br />of -a' <br />3 Gs -w-', Name rd M.J., Address <br />A. Slate Manifest Document Number <br />i.. .. ti <br />22390203 <br />4lj5o.j i%v17Son <br />B. Slate Generator's ID <br />A . Genermor'ssPhone(120 /4ki8--3064 f 201f 440'ldab <br />5. Transporter I Company Name 6. US EPA ID Number <br />C. Stale Transporler's ID [Reserved.] <br />- _ <br />' r <br />D. Transporter'. Phone <br />i ', ; - <br />(805) 987-0217 <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. Slate Tronsporter's ID [Reserved.] <br />a -a -.r; <}110 :rdi:5pert. :t. S u 3 3 n 3 - 1 13 3 <br />F. Transporter'& Phone (8001888-2597 <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. Slate Facility's ID <br />i L.Rj, e <br />.Ji:J ANfds1-..,.iP: is id�l.E <br />H. Facility's Phone <br />(370) 45.3-.7173 <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number <br />p (mc g p Aping I <br />12. Containers <br />13. Total <br />14. Unit <br />No. <br />Type <br />Quantity <br />Wt/Vol <br />I. Waste Number <br />_, c. <br />a. 128:. ;pt: •34AiE6�.. .- <br />Stale \p 1 C <br />GF <br />7�0o ry <br />i E <br />6131-11-711 <br />T, <br />EPA.COlisac /l,i �AtY <br />.i pt : <br />state <br />., <br />R <br />A <br />... <br />i U <br />T <br />. . .. <br />ins a <br />Stale l ' <br />...4' 1 Z <br />O <br />Ri <br />a. - _ J;ply"-9dNN✓M r <br />EPA/Other /V- <br />, <br />ATL <br />St _ <br />EPA/Other <br />J. Addit,onof Descn tjans for Materials Listed Above ;Vv7i,7 <br />K. Handling Codes for Wastes Listed Above Nft <br />11A: $/Y(3xn.3 1 ew 116: 7443$9' ( l4X SS 1 :e 11C: 6N4y999�((0%.(• <br />a. b. <br />j x r <br />C. <br />d. <br />15. Special Handling Instruction and Additional Infarmalian <br />Jed it 1463-)9811 Site :7850 S. RA Bradgefcrd 6t.8tocktan,Ca <br />Waite is RCBA exempt: per 40 CPR 261.4(L)(l� exclusion. lea ptcpar ?P -G when na:tdllng haia--dAus <br />CIaLCt].tl:.Y. - P110 3ll;ae 128 - 1-f <br />farttyea,r xlcacL LAa aAku'uf '. rlt -R.AC 24tiR. 800!536-§0.55.9 V .PE's .,- .... I- <br />16. GENERATOR'S CERTIFICATION: Ilkereby declare that the contents of this corsig nt are fully and no .... WI described above by proper shipping name and are classified, packed, <br />marked, and labeled, and are in all respects in proper condition For transport by highway according to applicable. international and nananal government regulations. <br />If 1 am large quamiry generator, I certify that I have r <br />p g m in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economic IIy <br />practicable and that I have selected the practicable methodaf treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health <br />and the environment; OR, if 1 am a small quantity general.,, I have made a good faits effort to minimize my waste generation and select the best waste management method that is <br />available to me and that I can afford. <br />Printed/Typed Name <br />SI Rlura <br />Month Day Vear <br />45 <br />a- 1i <br />Aqeink z U�r.,i <br />D U <br />TR <br />17Transporter 1 Acknowled ement of Receipt of Materials <br />A <br />Printed/Typed Nome <br />� <br />Signalure <br />Month Day Year <br />'z <br />Vin G�Z?` rZr <br />V�-A--�l-�a-,�... <br />I v ! b <br />a <br />18. Transporter 2 Acon wleditement of Rprisipt of Materials <br />B <br />......d/Typed Name <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />C <br />L <br />l <br />20. Facility Owner or Operator Cerlifimtion 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 />DTSC 8022A 1/991 Blue. GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />EPA 8700-22 To: P.O. Be. 400, Sacramento, CA 95812-0400 <br />