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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 is not required by Federal law. <br /> 0171 4161 4121 1�� OF <br /> q y� 3. Generator's Name and Mailing Address <br /> INTERLAKE�� MATERIAL <br /> 187 <br /> gg,AT IAL HANDLING INC <br /> 11503, <br /> Al, �tafe Mamfesk Document Nymber-.. <br /> S. blP4Ci'R -i`s 8 tr A�k4r� [ :..a s�. m,i ru � <br /> 4. G`enerator's Phone( ). A f9"9 i°4� <br /> B, state Generatr s 1D —^� <br /> 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter s.ID ties®Ned,}, <br /> EMAR } 011 Ta8L Ef,�f. VERVY S I' V. D Trans erter's Phane <br /> t� Q 03 [ 9 '7 f 2 9 P <br /> 7. Transporter 2 Company Name <br /> 8. US EPA ID Number E State Transparter's.ID Resewed.}. <br /> V `� Transporters Rhane <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Fgcif, 's ID <br /> Z% ,... <br /> .O '6251 f IL y 'Y.T"g_I��C RID. H. Facility's Phone <br /> U11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> k Z a. No. T pe Quantity Wt/Vol I. Waste Number <br /> W tai .f3 Sta <br /> EfNI <br /> f'kl ` w EPAOther <br /> o N 6. <br /> co E State <br /> v R <br /> A EPA/Other <br /> O T C. <br /> ® State <br /> R <br /> EPA/Other <br /> LU d, <br /> t•- <br /> Z State <br /> UjV <br /> U.1 EPA/Other <br /> N J. Additional Descriptions for Materials listed AboveLj <br /> Z ` K. Handling Codes For Wastes listed Above <br /> C. d: <br /> O 15. Special Handling Instructions and Additional Information <br /> Q L:Mf P GENCY CALL 1-4562-427-77-77 <br /> -;7 <br /> Z <br /> w �-BIU M APIC)NMENT RECD RYSEPV1`0'ES 03E PR(WEP SAFETY EQUIPMENT ERSW,0AG4842**HPft <br /> 2 <br /> r <br /> V-J� 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 /> J <br /> - If I am a large quantity generator,I certifythat I have a pume y 1 <br /> N practicable and that I have selected the prcticable method treatment,storage aared'sposall cur enly available toof ome ste which minimizes thnerated to the e present and Futurree I have e threat toeconomical <br /> humanhealth <br /> O and the environment-OR,if 1 am a small quantity generator,I have made a goodfa effort to mmize my waste get"eration and select the best waste management method that is <br /> available to me and that I can afford. // f <br /> } Print d yped N <br /> V Signature <br /> ♦ �! Month Day Year <br /> LU <br /> (� R 17. Trans 'ter 1 Acknowledgement of Receipt of Materials <br /> R <br /> LU A Printed/Typed Name <br /> fl Signatu� Month Day Year 4 <br /> LU S �G'}F <br /> u. 0 18. Transporter 2 Acknowledgement of Recei t of Materials <br /> I <br /> 0 T Printed/Typed Name <br /> Q R Signature <br /> Month Day Year <br /> V F 19. Discrepancy Indication Space <br /> Z A <br /> C 1� <br /> L <br /> f <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered 6 this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature j <br /> Y Month Day Year I <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/99) <br /> EPA 8700-22 Yellow: GENERATOR RETAINS <br /> t <br /> 3 <br />