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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 qe 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for usebn elite ,iter. Sacramento,California <br /> P <br /> UNIFORM HAZARDOUS 1• Generatar's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST C of <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> I=Vww= 20718238 <br /> S(.�� B. State Generator's ID <br /> Abera"t'or's one~ <br /> CV 5. Transporter 1 Company Name 6. US EPA ID Number C. Stl Tr arter' ID,[Re erved.1 <br /> LO <br /> 100f <br /> OEEC TAI. TECII. <br /> C rJ +� D. Transporter's Phone (69)324-16M <br /> O <br /> aD 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 /> Z n aC v1 H. Facility's Phone <br /> 0 2 1 BAY ROAD C A D B 0 S 4 5 2 (&%)324-1638 <br /> " <br /> 'mow <br /> 12. Containers 13. Total 16. Unit <br /> V <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol I. Waste Number <br /> . Z a. W 1 11 State <br /> S213 <br /> EPA/Other <br /> G Prfl& E 32W ERN 127 DW <br /> O N 6. IIa�.'e" L ACETATE 3 111231 TI State <br /> a0o E <br /> NR �y EPA/Other 214 <br /> Iq A4118 E 341M MR 129 DW <br /> { <br /> O T c. LI LO.S. 3 III State <br /> aOD O { 8 AI ' } 511 <br /> EPA/Other <br /> REd 11 E 3112C OP 1'1 .i ilt` r 'Al i! <br /> LU d. State <br /> Z <br /> w <br /> V EPA/Other <br /> J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> f . s - a 6 <br /> 0 01 <br /> C. d. <br /> Q <br /> Z 15. Special Handling Instructions and Additional Information 24 HR. MUMMY RMMS9 #j =2103-351111111 <br /> Q <br /> Z <br /> w <br /> I— <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 /> J If I am a large quantify 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 /> n practicable and that love selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> rn <br /> and the environment;OR,if I am a small quantity generator,I have made a gogd faith effort to minimize my waste generation and select the best waste management method that is <br /> cle available to me and that I can afford. <br /> 0 <br /> Pr' /Typed Name ,;I � Signature <br /> l �:�� Month Day Year <br /> Z <br /> 1,-''�� . !'f <br /> 7 - �; <br /> w R 17. Transporter 1 Acknowledgement of Receipt of Materials / <br /> LU A Printed/Typed Name Signature Month Day Year 1 <br /> R C € k( (,7 <br /> w S T^^'VIA le v a �s zt 11-f vv 1 <br /> �'f f <br /> C <br /> 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> TPrinted/Typed Name _ - Signature Month Day Year <br /> LU E <br /> N R <br /> Q <br /> (•,1 F 19. Discrepancy Indication Space <br /> Z A <br /> C <br /> ( <br /> L <br /> l 20. Facility Owner or O erat Certification of receipt of hazardous materials covered b this manif t xce t noted in Item 19. <br /> Printed/Typed N e j Signature Month Day Year <br /> r ereme Nation E IN04M DO NOT WRITE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> 22A (1/99) (Generators who submit hazardous waste for transport out-of-state, <br /> DTSC.80 <br /> EPA 87022A produce completed copy of this copy and send to DTSC within 30 days.) <br />