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State of California—Envl... mental Protection Agency <br />Form Approved OMB No. 2050-GO39 (Expires 9-30-99) See Instructions on back of 3e 6. <br />Please print or type. Form designed for use on elite {12 -pitch, rifer. <br />C <br />w <br />z <br />U <br />U <br />su <br />ul <br />0 <br />w <br />aY <br />Cz� Department of Toxic Substances 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) IGenerafors who submit hazardous waste For transport out -of -slate, <br />EPA 6700-22 produce completed copy of Ibis copy and send to DTSC within 30 days.) <br />UNIFORM HAZARDOUS <br />1. Generator's US EPA ID No. <br />Manifest Document Na. <br />2. Page I <br />eformation in the shaded areas <br />WASTE MANIFEST <br />r7 C b j <br />d <br />is not required 66 Feder III <br />_ <br />C i# Hi 1111.110101"ry <br />(' �T ^.'4 <br />of y3 <br />c: <br />J <br />3. Generator's Name and emuglnp Address <br />A. Slate Manifest Document Number <br />2239®293 <br />r <br />Allf5o,j NuDSon <br />B. State Generator's lD <br />4 G ervbr's Phone 1 ) '�` 1 n' <br />t ' lJln` <br />I <br />I <br />5. Transporter I Company Name 6. US EPA ID Number <br />C. State Transporter's ID IReserved.j <br />1 <br />t <br />D. Transporter's Phone <br />t <br />_.._ _.,... ... Tj a I <br />7 Tmsa5.rter 2 Com any Name <br />�,p 8. US EPA ID Number <br />�'�`•� <br />E Stam Transporter's ID [Reserved.] <br />11'Nu'il �(,✓i-` ) }: D � S' I <br />F. Transporler's Phone <br />t £YQ'L'a E'89='2597 <br />i <br />'o <br />Jp <br />9 Designated Fac I ty Name and S Ie Address 10. US EPA ID Number <br />G. State <br />ciliyr/s /y'` <br />Q k <br />s <br />H. Facili s Phone <br />11. U5 DOT Description I din Pro Shipping Name, Hazard Class, and ID Number <br />(including g per pp' g I <br />12, Containers <br />13. Total <br />14. Unit <br />No. <br />Type <br />Queer, <br />Wt/Vol <br />L Waste Number <br />sa rs: L.K1.. _. .L' 3. ?G 1., (00@-S R1162d) <br />felg: <br />State <br />7704"1y <br />E5AL- <br />G <br />0 <br />E <br />_.. <br />3 1 <br />Nb <br />At=M., <br />. (pl: <br />State <br />E <br />7°1'P7fJ <br />' t <br />EPA he <br />R <br />T <br />State <br />0 <br />R <br />W <br />•.- �_.. :`y'( a,ue.wNT <br />r 1-4 <br />EPA/Other <br />d. <br />st r <br />EPA/Other <br />A Additional Descriptions Far Materials listed Above %'lYi,'t <br />'7 <br />K. He ng <br />C for Wastes Listed Above <br />y7Ct <br />?1B: 3.43b4+P f 1NX SS ) ** 11C: <br />y 4 <br />ZAt iyk3�{t�Jrf' <br />a y'� <br />/ <br />M1 6 C!" <br />c. 4� __ <br />l i . <br />15. Special Handling Instructions and Additional Information <br />!f 1492-0431� ;ir. :'t05Q 9. PAA BrldaeParrl 9[. Stockton. Ca <br />n+. d is l!9i2A eXEi^[eL ji4:L v'ti �.,+F. M1.4/bl ..1, e;<Clttalon. 090 *ron%r <br />Pox. wr`9-q .len l-tc; k-A."e2'dous <br />16 GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurate) i d b d b by p p shipping name and ore dassif ed, packed <br />marked, and labeled, and are in all respects n proper condition for transport by highway according to app) cable mlernolional and national government regulohons <br />If I ons a large quantity s <br />generator, I certify that I have a pro cons in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br />Practicable and that I have elected the m ethod of treatment, disposal to future human health <br />practica6le storage, or currently available me which minimizes the present and threat to <br />and the environment; OR, it am o 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 />available to on. and that I can afford. <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />� . <br />z, <br />t 2 <br />T <br />17. Transport 1 Acknowled a ens of R,', t of Materials <br />M <br />Printed/Typed Name l <br />Signature <br />n <br />Month Day Year <br />14 <br />\ /� <br />R <br />18. Trans otter 2 Acknowled ement of R ei t of Materials <br />RPrinted/T <br />T <br />EF <br />ed Name <br />YP T <br />/ i <br />Signature <br />i <br />Month Day Yeo. <br />`J <br />`" <br />, ./ <br />I <br />C r' it <br />19. Discreponq In tcotian Space <br />_ <br />F <br />A <br />c <br />f <br />L <br />I <br />20. Facility Owner or Operator Certification of receipt of hazardous materials <br />covered by This manifazt e t vh.t.y in It.. 19. <br />T <br />Printed/T pt Name— _ ) A• ' <br />Signature <br />DO NOT WRITE BELOW THIS LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />DTSC 8022A (1/99) IGenerafors who submit hazardous waste For transport out -of -slate, <br />EPA 6700-22 produce completed copy of Ibis copy and send to DTSC within 30 days.) <br />