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State of California—Environmental Protection Agency See Instructions on back of 6. Department of Toxic Substances Control Form Approved OMB No.2050-0039(Expires 9-30-99) Piease print or type. Form designed for use on elite 112-pitch)fuer. Sacramento,California 1. Generator's US EPA ID No. Manifest Document No. =PageInformation in the shaded areas UNIFORM HAZARDOUS is not required by Federal law. WASTE "MANIFEST C � tt 0 Z u ;? 2 +7 2 2 0 3. Generator's Name and Mailing Address A. State Manifest Document Number PION �� a 4945__ WATERLOO RD- B. State Generator's ID O 4921-7:4 72 8 Gen o rs �_l_ 9illS t\ N 5. Transporter 1-Company Name - 6. US EPA ID Number C. State Transporter's ID(Reserved.] L aD D. Transporter's Phone o 3110P HAZARDS SOLUTIONCI 11711111 1416149 0 CP 7, Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] J F. Transporter's Phone J U 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID g k,1:gERAL ENVIRONWRIAL Q_' 11855 WHITE FSO] RD H. Facility's Phone O RANCHO CC4W01C 95 Q12. Containers 13. Total 14, Unit U 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol I. Waste Number State Z a. _ PQ, Waste Paint related material 2, U111215s, ~ 11 iGQ71,FUt73,t EPA/Other G CIF 1 f2 0 E State o N b'R;, Waste Paint related materials, 3, U14126s, 00 cc) E ?I tDUUi,FU�3? EPA/Other v R 0 r� l D f, 0 0 8 0 A e State o T gt;, Glance F'lammaille liquids, toxic, n-c,.1 :i, co O U111992, 71 %xplsn. Pc3yisaoynflatei tLJ001, EPA/Other R �1 0 1 L1 E it 1 u o State d.Ida-te Toxic liquid, inorganic, Z ltfi 28'?r III (magnesium hexa£lauroft ilicaGe-) EPA/Other s F0 h 11 8 0 P J. Additional Descriptions for Materials Listed Above K. Handling Codes For Wastes Listed Above rya ro tiff. ''9fi d) Uj cke ' b GEM has th appropriate d. Z15. Special Handling Instructions and Additional Information permits for and will accept APS �, ` PRt}rP£CTI�'E r.�+v�t�ttztn� the waste this generator is Z ^EEMERG£ rCY CONTACT: i800� 1465--7449' LU shipping. 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are Fully and accurately described above by proper shipping name and are classified,packed, Umarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. 2 IF I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically sn practicable and that I have selected the racticable method of treatment,storage,or disposal currently available to me which minimizes the present and Future threat to human health and the environment;OR,if I 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 cc available to me and that I can afford. O Month Day Year P`tny�..da/Typed Name Signature >. Z ;5 T 17. Transporter 1 Acknowledgement of Receipt of Materials � R Signature Month Day Year 0161 LUp Printed/Typed Name y R L LU S sL p 1 B. Transporter 2 Acknowled ement of Receipt of Materials ' O T Printed/Typed Name Signature Month Day Year w E sn R U 19. Discrepancy Indication Space IF k� a F & HLONSTRU TI . 1 - O � l�f� � 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. A (� Printed/Typed Name Signature Month Day Year / 20 05 . r, DO NOT WRITE BELOW THIS LIN �� V��u L> Yellow: TSDF SENA fi i WITHI 0 DAYS. (Generators who submit h ardous waste for transport out-of-state, DTSC 8022A(1/99) produce completed copy of tti4s.copy and send to DTSC within 30 days.) EPA 8700-22 _ 437�