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State of California—Environmental Protection Agency r: Form Approved OMB No.2050-0039(Expires! d 94� See Instructions On back Of a 6. Department of Toxic Substances Control Please print or type Form designed for use.&'efitc`Ill-pilch)oliter. Sacramento,California e ].—Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas tt UNIFORM HAZARDOUS.- is not required by Federal low. WASTE MANIFEST1 :71� D 7 $ 6 � C� of 1 3. Generator's Name dnd Mailing Address A. State Manifest Document Number I .1 2,0717942, ion S. sicnam B. State Generator's ID _ ertera7o�'r's one( M-3m cwtwt. MM Flom, N 5. Transporter 1 Company Name - 6. US.EPA ID Number C. Stare Transporter's ID[Reserved.] 00 0o I,a MINEWAL Tn. P4 3 D. Transporter's Phone 46MI324-1638 g oD 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] ay - F. Transporter's Phone _. . . V 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID Is.I A I D �Z EOSIC ENTI AI.. TER H. Facilitys Phone CZ:p 1 EAI° A 9 1� S '$ S � � t 1 $ t u- FAST 7 � 12. Containers 13. Total 14. Unit Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol 1. Waste Number Z a- VA M.A 3 L91VA II .;State. 3 541110 a � e7 �� p� EPA/Other c> Eb. 1] II ATE °.� 2.'31 II00 214 stare o N 65 EG/" EPA/Other C a (11615, ti's �:� 77 5' 6— psi LIQUIN I.C.S. 3 IM19MIII state 0O WDI ., AIfIIED, ) 512 EPA/Other R7 I State � - w d. t- Z w V EPA/Other J. Additional Descri tions for Materials Listed Above K. Handling Codes for Wastes Listed Above WW c. d. a Z 15. Special Handling Instructions and Additional Information 24 HR. UMUCT ' I I t= Q Z LU S r- 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, Q marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. V - -J 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 hpracticable and that I have selected the practicable method of treatment,storage or�islp sal currently available to which minimizes the present and future threat to human health and the environment;OR,if I am a small quantity generator,I have made q hood faith Fort to minimize my waste generation and select the best waste management method that is Oavailable to me and that 1-ca fford. - } / r Printed/Typed Name .�,✓ Signature .r ` �" ;/``,,r"f IMonth Day Year 0 T 17. Trans ower 1 Acknow gement of Receipt of Materials " R LU p Printed/Typed Name :'/'[f f.` Signature j /`d �yMonth �DayJ gYear, WS f .r r'/l,l� t� �-.✓ er`.s�".Q `> f ra„c�'r a:'; r f../ �+- 0 18. Trans orter 2 Acknowledgement of Receipt of Materials TPrinted/Typed Name Signature Month Day Year LU E cn R Q V F 19. Discrepancy Indication Space ZA _ C L 20, Facility Owner or O erator Cert'ication of receipt of hazardous materials covered by this mo est except as noted in Item 19. 10 1 T Printed/Typed Nj� Signarur Month Dayr Year 1,2 DO NOT WRITE BELOW THIS LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. 22A(1/99) (Generators who submit hazardous waste for transport out-of-state, 0-22 DTSC 80 EPA 87022A 1 produce completed copy of this copy and send to DTSC within 30 days.)