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State of California—Environmental, Protection Agency <br />To Approved OMB No. 2050-0039 (Expires 9-3099) <br />Pleas' rim or type. Farm designed for use on elite (lt-pitch) <br />y <br />N <br />n <br />m <br />O <br />jQ <br />U <br />D Q <br />�04 <br />70 <br />7 Q <br />U <br />z_ <br />x <br />3 <br />See Instructions on back of le 6.� Department of Toxic Substance, Corral <br />iter, AC <br />N Sacramento, California <br />DO NOT WRITE BELOW THIS LINE. <br />Yellow TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />(Generators who su6m'it hazardous waste for transport out -of -slate. <br />DTSC 8022A (1/99) produce completed copy of this copy and send to DTSC within 30 days I <br />EPA 8700-22 <br />7. Genera' 's US EPA ID No. Manifest Document No. <br />formation in the shaded areas <br />A <br />I,UNIFORM <br />HAZARDOUS <br />gg�q, <br />s Q— 941 <br />s nmregaled by,. Federal law.': <br />-' <br />WASTE MANIFEST <br />-{4 7 r ;tf <br />3 G neromr s Nisme and Meiling Addresswi p ;-, Sy,;a <br />` <br />A. State Manifest Document Number <br />23596627 <br />1,EPrt <br />B. State Generator's ID <br />- - <br />A. Generators Phone 7 <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C. Stale Tmnsportei s ID [Reserved.) <br />I „_-.. y_ _•-' [-. '. '- <br />11 1 LL. I_ <br />D. Tronsportar's Phone <br />OF 81 4432- <br />�. <br />E. State Transporter's ID [Reserved] <br />n <br />7. Transporter 2 Company Name 8. US EPA tD Number <br />.. _ <br />' <br />F. Transportei s Phone {d1, 957•$M <br />9 Des g .ted F c ty Name and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />HE F.,d ty s phone <br />I ' i I <br />r3Wrt :i <br />11 US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />p (i g p Aping <br />12. Containers <br />13. natal <br />Quantity <br />1 d. Unit <br />Wt/Vol <br />I. Waste Number <br />No. <br />Typo <br />State 343 <br />G <br />:=t' --. �O;;J;t <br />q 2 <br />D <br />il6 <br />P <br />EPA/Other <br />WI <br />N6:' <br />-.. -. - _ --s., . _ <br />State 513 <br />-- <br />EPA/Other <br />R <br />Doi, TIDOS <br />Tc- <br />state 231 <br />O <br />_ <br />r"'1 I <br />�.y <br />L"' " } <br />EPA/Other <br />R <br />.. _ <br />;..;-y-I- <br />rree <br />!11_LI <br />_ <br />owl <br />d.-. <br />SmteEJ2. <br />- - - <br />EPA/Other <br />J. Additional Desc tions for Mate els l sten( Abpve ..,U3a a -t Ge <br />1iA •SfltN�tT1'ss 9 j�'�.'.y`.7�� UOD <br />K. Handling CogEs. For Wastes <br />Listed Above <br />;Cltu7,C+00ef.LihutF.g <br />I IS 5&,-dC1-4 J 7�E ?f'%�G D0071.u006.D019,0 3,5 <br />a. <br />1 i,—* 500-30854 d <br />i 1 W' 50030031 E - L t) U17tD135.F002.F003,FG05 96 <br />IS Sp I, Handling Instructions andAdditional Information 07 1 T t <br /><-AU;,,:-06135 17I;7 <br />16 GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accuralely 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 notional government regulations. <br />generate,, I certify that I have a prm in place to reduce the volume and toxicity of waste generated to the degree I have determined to be occur, ally <br />If I am o large q anti , <br />and that I have selected the method.fgg treatment, storage, or disposal currently available m me which m izes the pr. sent and future threat to human health <br />practicable practicable <br />and the a. ironmenq OR, if I am a smallquantity 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 me and that I can afford. j <br />Typed yy <br />e (,�', <br />PJ (P •3/!n3 % <br />Sign ore \ <br />Momh Day Vear� <br />2 ( O <br />� Iti/Y 0 <br />T <br />17. Transporter 1 Acknowled emeet of Receipt of Materials <br />pPrinted/Typed <br />Name �,.... // <br />SrgCfjure / �,. <br />Month Day Yepr <br />P <br />0 <br />c <br />18. it der 2 Acknowled cement of ei t of serial <br />R <br />T <br />Printed/ ped Name ( <br />i i/- <br />Signature <br />Month Da Year . <br />Y <br />i _T <br />' i t <br />19- Discrepancy Indication Space t <br />F. <br />A <br />C <br />I <br />20. Facili Owner or Operator Certification of recru t of hazardous materials covered by this manifest exce t prrrated wthenj 9_ 1 <br />T <br />Printed/Typed m - f <br />Signature - F <br />r d <br />�onM DpY 6 �� <br />i ( t F �' <br />Fm <br />F <br />r <br />DO NOT WRITE BELOW THIS LINE. <br />Yellow TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />(Generators who su6m'it hazardous waste for transport out -of -slate. <br />DTSC 8022A (1/99) produce completed copy of this copy and send to DTSC within 30 days I <br />EPA 8700-22 <br />