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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 a 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12-pitch)Oriter. Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST C A D a 7 4 6 4 1 of is not required by Federal law. <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> TUE"ut <br /> NMMTD <br /> 8: State Generator's IQ <br /> LO <br /> LO %erator's ones( <br /> "CV - 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.[, <br /> o IC AL li 11111111, S D. Transporfer's Phone <br /> W 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] <br /> QF. Transporter's Phone <br /> V 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> �Q C I A I D D <br /> Z EEC ERVIROPTAS, . e+ <br /> ce _*1 BAY D C A D i a 9 4 3 H. Facility's Phone [ ] ^" ,. <br /> O EAST PAID ALM. FA %Xl <br /> JQ12. Containers 13. Total 14. Unit <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> s g V No. Type Quantity Wt/Vol t. Waste Number <br /> tl Z WARE P IV REUTED IIATERIAL 3 L911263 II �t state <br /> !_ fPA/Other <br /> 3 GVEdit E 2914M M 127 1P I Z ") a ® p 1 0 tJ <br /> N E b. VASTE ACME 3 2 II State <br /> 00N <br /> 00 <br /> E EPA/Other <br /> C A WHEMM E0127 a ,0 P.! '? 0' <br /> ca T VA YL ACETATE U91231 II star® <br /> G <br /> EPA/Other <br /> R <br /> Milli E 341372 EM 129 ® P I.S D ttL 0101 ?-1715 <br /> w d. KIMBLE LIgUIDS, L .S. 3 U11993 III State <br /> Z (RESIDUE: LAST A ,A 3 <br /> VEPA/Other <br /> Wit E 301247 125 01 019 °0 , 01 h A 12 16 <br /> J. Additional Descri tions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> a. b. <br /> ' c. d. <br /> Q A <br /> Z <br /> 0 15. Special Handling Instructions and Additional Information 24 U. EMMEY 10M 4; 13M)3M <br /> Q <br /> Z <br /> LU <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 /> < marked,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 economical) <br /> a- practicable and that lave selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human healt <br /> N <br /> 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 <br /> a' available to me and that I can afford. <br /> 0 <br /> Printed/Typed ? Signature Month Day Year <br /> Z `"�,, '' .. .. /t <br /> tts RT 17. Transporter 1 Acknowledgement of Receipt of Materials - <br /> LU A Printed/Typed Name Signature Month ,gDay Year <br /> R erac.s♦.•tJdar°sl.� 4�I:�r%?,L/. <br /> LU 5 shJl .sa.: t'.r5,1-7jj. <br /> LL- 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> TPrinted/Typed Name Signature Month Day Year <br /> uu E <br /> h R <br /> La) 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> L <br /> l 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 /> Refeream R r: E IIM1351 DO NOT WRITE BELOW THIS LINE. <br /> DTSG8022A(1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />