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a of I!Vjornia—Environmental Protection Agency <br /> i Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back of a 6. Department of Toxic Substances Control <br /> e print-•type. Form designed for use on elite(I 2-pikh) iter. Sacramento,California <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal law. <br /> WASTE MANIFEST a .c tl 0 2 g 11 `? 2 1 U d G A of <br /> Tt3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> F WAW1 RD. B. State Generator's ID <br /> LnGenera ors Phone t <br /> N <br /> N 5. Transporter 1 Company Name '6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> oo D. Transporter's Phone <br /> o '4r1•-%L� I"ilk'ARDS 1C)Lp.1`T'Zt�l�a C I! f t3 4 Fj 44 P <br /> 0 <br /> CP 7. Transporter 2 Company Name B. US EPA ID Number E. State Transporter's ID[Reserved. <br /> rQ F. Transporter's Phone <br /> V9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> Z H. Facility's Phone <br /> oc f 1. w td: ITE V�OCK KD. / <br /> O fi.-4sfC'tV: C'0Pjj0VK CIA -R`i 2 r <br /> kf Q12. Containers 13. Total IA. Unit <br /> V 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No Type Quantity Wt/Vol I. Waste Number <br /> Z a State <br /> = RQ Waste Ya3,nt r:elsxesri rsateriaAr <br /> Ci .'1,i t:�IF`,i t.+.l , �'+it c.il� �!+ - EPA/Other <br /> l� f C L F w r) ci <br /> O N b. State <br /> oo -4' 1 A-At.te b�,anni t:s.l;It:a,f via <br /> oo Ej r t r F tt t r EPA/Other <br /> C14 0,1 root <br /> VV A c State <br /> o T }±.d. �.xtr:e };�tmtnxak:ia ijquidtvi ; <br /> , tcis n .c,. u <br /> ado O LsIIL�Se., I7 i�y']a'r. Ee,l i� t t,atrl Dit(II EPA/Other <br /> kl 5 is <br /> f t7i};f <br /> Lu d. State <br /> wazte TkuF,iC ii:,tgt.zact, intmj2r. t,_c a . . 6. 1. <br /> Z UYI-2 :t!':t, LZi 4saar{rre esus I-lexz f AC)U r cz z?ic-ute_: EPA/Other <br /> Lu <br /> 1. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> jf 1 box #14—t�r 1$' �i !gl I�� .Dit W b. <br /> wit!ltt9fi. 12 c3 Llt '1r1E81i1�Itr ' d) <br /> t<llt �4 r)`� Ir� MDQ r c. d. <br /> J <br /> Q <br /> Z 15. Special Handling Instructions and Additional Information <br /> O <br /> Z "f+4EP.GF11:Y +':>Itl'7s.t`�f t ltiIt3 ?�1E 7�+'gun <br /> Lu <br /> I& 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, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> J <br /> —� 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 economics y <br /> a- practicable and that ftave selected the racticable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> N <br /> and the environment;OR,if I am a sma I 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 me and that I can afford. <br /> OPrinted/Typed Name Signature g* Month Day Year <br /> Z <br /> w T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> RMonth Day Year <br /> Lu A Printed/Ty Name ✓ �.{ Signature <br /> Lu <br /> 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> T Printed/Typed Name Signature Month Day Year <br /> w E <br /> u') R <br /> V19. Discrepancy Indication Space <br /> Z F <br /> C <br /> I w A <br /> 20. Facili Owner or O erator Certification of recei t of hazardous materials covered b this manifest exce t as noted in Item 19. <br /> Printed/Typed Name Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />