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State of California—Environmental Protection Agency " 8y 13 <br /> Form Approved OMB No.2050-0039(Expires 9-30.99) See Instructionson back Of e 6. Department of Toxic Substances Control <br /> print or type. Form designed for use on elite(12-pitch)Oiter. Sacramento,California <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS CAI)`>4642-e0 . 333 3. is not required by Federal law. <br /> WASTE MANIFEST of <br /> rat q's a ( A rens ' A. State Manifest Document°Number <br /> 0 D 1, r+ ,^ e b,t`1•r✓ Qi•'%r c`ft, :8.•5tate.Generat�r`s,ID ,,w - <br /> M <br /> to A. Generator's Phone ('""�°���) `5'�'"° 31 5 0C <br /> r ,a t a•� <br /> N 5. Transporter 1 Company Name 6 US EPA ID Number C SHste7ransporter'57id(Reserved Y <br /> aP �4 "i L f4a a?i «.. i. 1 t.r4 ;KR 0fr.100 5150 <br /> D,Transpanfer Sµf"fiorre <br /> o r , <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporters ID[Reserved.] <br /> J <br /> QF. Tronsporter's Phone <br /> U F5lOnat d FAri ty Ran �ittaAddF.®s 10. US EPA ID Number G. State$F. i r <br /> _ tOO p"r <br /> Q <br /> ' . Facility's Phone <br /> H 4, <br /> 12. Containers 13. Total 14. Unit <br /> Q <br /> U 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol 1. Wast®Number <br /> Z a _. .. 71 <br /> State <br /> .Gij 'FE:-Dr <br /> 3i G A(K) >fTjS,... )8R1 Wt SHF-1 .,,CR–I TION (s, ,..f�fOatsl._, f+� �fAlC�ther, 4 <br /> C;4 <br /> N b. r' (< `t State <br /> 00 E <br /> -4 R EPAlCftlier <br /> v A <br /> o T ` <br /> State' <br /> ao O <br /> R � PA(Other'' <br /> wt— <br /> J. State' <br /> Z <br /> U EPA/Othe7' <br /> r <br /> J. Additional Descriptions for Materials Listed Above 1X-Handling,Codes for Wastes Listed Above= <br /> b. <br /> LU <br /> J <br /> Z ,,1 � •J S s�.ia J w r <br /> }� Ins A b 1 lona) n otian <br /> a <br /> 9:; AU!fliQfi.-t: ZEI) TC) F171 rf;Tki 1 TZ_N,5E7D iM:U : EQUEE -r CArRi Ir E.',P, IS'', tJECESSA3; , <br /> Z <br /> t— <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 /> N and the environment;OR,if 1 am a small quantity generator,I have made a good faith WWI to minimize my waste generation and select the best waste management method that is <br /> Oavailable to me and that I can.dffi rd. <br /> } <br /> me Printed/T d N % <br /> Z � / Signature /' _ f f., y Month Day Year <br /> } i'V�y°1 pf" ,+'y��% ' .fg }t�,,•'tp .-. �.,,r%'",Q' •^'- .. / _. . '-- <br /> s fi <br /> w R 17. Trans orter 1 Acknowledgement of Receipt of M rials <br /> <w p Print+d/;T}iped Name d _ Signature }- Month Day Year <br /> u- 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> T Printed/Typed Name Signature Month Day Year <br /> U.1 E <br /> Q R <br /> U 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> i <br /> 20. Facili Owner—O erator 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 /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) <br /> EPA 8700-22 Yellow: GENERATOR RETAINS <br />