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+ State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9.30-99) See Instructions on back of ge 6. Department of Toxic Substances Control <br /> ease print or type. Form designed for use on elite(I%itch ricer. Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by federal law. <br /> l�,a <br /> WASTE MANIFEST Q 7 S 4 8 I � '� I of 1. <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> S. MUMB. State Generator's ID <br /> Caltad, EM 91= <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> LO <br /> 00 <br /> o IC V � . 2 51 7 D. Transporters Phone (M324-AM <br /> O <br /> 00 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] 5t <br /> � F. Transporter's Phone <br /> a <br /> V 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> X. Q If 19 10 1 S 4 .5 2 6 5 7 <br /> Z ROOK EVIROKMAL TM H. Facilitac <br /> y's Phone <br /> Q I SAY p 9 � S 5 7 i `" );%4-IIt <br /> 11 94:w I <br /> Q11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> V <br /> e� No. Type Quantity Wt/Vol I. Waste Number <br /> eV Z a.V ACM A I II State <br /> 2132 <br /> ~ EPA/Other <br /> E fit 32M 90 1" <br /> O N b-VAM IM AWJTE 3 01MI II State <br /> co <br /> coo E 214 <br /> R $ Pa} �J EPA/Other <br /> v61 3 <br /> W11 E 3417M =1 199 011111 <br /> c.� " 1.I L ILS. 3 t 1 IIT i t State <br /> ( , 8 <br /> pT <br /> Rf /°; i#Iq ,f / EPA/Other <br /> i MIA E 301M MW 128 ( d`� 1ME <br /> Uj d. State <br /> Z <br /> LU <br /> V EPA/Other <br /> JL. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> U <br /> C. d <br /> Q <br /> Z 15. Special Handling Instructions and Additional Information <br /> Q P 9 W e ( ) . ..�S' <br /> Q <br /> Z <br /> w <br /> 2 <br /> H <br /> 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, <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 /> 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 <br /> practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> V) and the environment;OR,if I am a smaquantity generator,I hove mode-a•saod faith effort to minimize.,my waste generation and select the best waste management method that is <br /> available to me and that hcan afford. , <br /> Q <br /> Pri yped Name ,/,/ ,/�` Signature ✓' � Month/+ Day Year(/`, <br /> ��4 <br /> w RT 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> w A Printed/Typed Namei < Signature / .7 r, a� } Month Day �Yrear <br /> w <br /> S �At .t� a�a...s�'.�/4,,...el L ,/r ;-.F ^=�,.+r✓",,,... ...� 1. t;. („/' a�.,;i <br /> U- 0 18. Transporter 2 Acknowledgement of Recei t of Materials <br /> Q B Printed/Typed Name Signature Month Day Year <br /> LU E <br /> Q R <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> _ A <br /> C <br /> L <br /> 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> Printed/Typed Name Signature Month Day Year <br /> Ref c S INKM DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/99) <br /> EPA 8700-22 Yellow: GENERATOR RETAINS <br />