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State of California—Environmental Protection Agency Fq!rn Approved OM9 No.2050-0039(Expires 9-30-99) See Instructions on back of 6. Department of Toxic Substances Control Please prtnrcV type. Form'designed for use on elite 112-pitch) der. Sacramento,California UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page"1 Information in the shaded areas of WASTE MANIFEST a �' ' G 1' 9 Z'111 .112, °1 � � `� � � � is not required by Federal law. , Geng�a} r �1gcI �IPjAfldress A. State Manifest Document Number _ 4945 142MML00 PD-s``44 2` 4311476 LO rrt 9 m c a, B. State Generator's ID LO 4. Generator's Phone(2 0 9 N S. Transporter 1 Company Name 6. US EPA ID Number C. State Transporters ID[Reserved.] to 00 svm &� i„ r' D. Transporter's Phone CP 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] QF. Transporter's Phone V 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID Z -E,� +'5 IM,IriSE, ROCI K V-1. H. Facility's Phone "y � "• t ul r'trt dv:? tim !s"�'i . r.` ?t 8 .s :i t j C%51.-0i a0 d Q y 12. Containers 13. Total 14. Unit V 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol I. Waste Number Z a. 7, ;� 3nzt� . � ictN _�t.u.R State ; t=—F U 3 G Etarif 2., ill� F [0 dt Yj F.?( l ;l 1. 'h ' x Et;� si� 'f3bt NE b. t s 1 .• State a8o E iF%*1;._FZ."P*A M-2X t 1"Due MR11d`1L, .iso 1X):D st R f! 'a } �[. fj 1. !. t""; EPAOther T S o T C. 4,air :SLA E:T State 000 0 vola-.P IP41L —71 lvflhz r� SOLID -� R EPA/Other LU F, v.c�.°4.Y 1'jt. ,rnR^'' ;tomR State Z i . 3 aid �W&m)4�'�x cora, wy"s'T�; �, 'i..Txu a d �. EPA/Other V 4,. J 4 % _ rq 01nfl�n— 1. Additional Descriptions For Materials listed Above K. Handling Codes for Wastes Listed Above b. CL LMG#1. } b? }£::Cd�i� � g ZaE i L ERG #171 U-1 Co PROFILEv' 9- : ERI #171 ) PROFILE C. d. QZR. . :t . Z 0 15. S c}AAecial Handlin Instructions and Additional Information a�2�:: 5''e}�� 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, Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. —�' if I am a largeq uantity generator,1 certify that I have a pro ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically Npracticable and that I have selected the practica6le 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 available to me and that I can afford. OPrint/Typed Name"' Signa urge' � Month. Day YearZ 11 , a p C0 H 1%. Transporter 1 Acknowledgement of Receipt of Materials iAF w A Printed4Typed Name Signature gg Mont_ Day, Year w P 3>,+i° t' (, � /K, -e, �f LL ' 18. Transporter 2 Acknowledgement of Receipt of Materials TPrinted/Typed Name Signature Month Day Year w E to R V 19. Discrepancy Indication Space Z F A C I L 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. Printed/Typed Name Signature Month Day Year DO NOT WRITE BELOW THIS LINE. DTSC 8022A (1/99) Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. EPA 87022A To: P.O. Box 400, Sacramento, CA 95812-0400