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of CaliFor i�—Environmental Protection Agency Pr t 1 6306 <br /> 5tai 0-99( <br /> For 'Approved OMFt 4To.X050-0039(Expires 9.3See Instructions on back Of @ 6. Department of Toxic Substances Control <br /> ?a P dse print or'ype. ' orm designed for use on elite(12•pitch) iter. Sacramento,California <br /> 1. enerator's US EPA ID No, Manifest Document Na. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal law. <br /> A <br /> W TEMANIFESTID 10 ID 0 1 of 2 <br /> 3. Gner s N6meonV Mailing Address A $iota Man6fes9 f ocktstserst fOmf P <br /> - t' r vtt gte; <br /> '00411 <br /> NPANE w <br /> .. <br /> Gmeram s:Pft�ne (209 I 0 TAM: .� .' <br /> CV 5. Transporter 1 Company Name 6. US EPA ID Number `-'';tatep§Ai9. ;#1s }, s`. <br /> h r <br /> O VAW YYt9J-ERS ROGER+7 INC <br /> o OF4D © 109255 ' ., fi4 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E State 3s4nsporter,'1DRserve 4 ' " - <br /> _ <br /> VAN : S 4. .XMZ F Transporter s P}ctea w <br /> �»„Q C. A D to 1912 0 12 14 14 <br /> " V 9. Designated Facility Name and Site Address 10. US EPA ID Number G. 5ta3e'FacHity' iD ' p <br /> Z PO BOY i Facility's Pane_CY,MT ROAD , <br /> r <br /> Dv3$� A 66736 [� D 9 0f 6i 3 ? "i 4 <br /> 12. Containers 13. Total 14. Unit s• t 4= <br /> V <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No Type Quantity Wt/Vol f Wsrs"urit $ ' <br /> -R TE PAINT MATBD MATERIAL <br /> 113, 263, 1G 11, ( 100): 0�x D001 D03.5`), <br /> 3 G 1.27) lk IN IL �\J� C1 D <br /> N` E 6RQ pAM RELATED MATERIAL <br /> coco E 3, UN1263, Pty II, ( 100), (EPA r003 DOfII)r / .. <br /> R {ERG 127) ln)Cy� �'' S�JB�' ' '� �y �� 41- �� <br /> o T c. <br /> co 0 <br /> R <br /> w d. � 1 <br /> Z <br /> w <br /> V <br /> IK 'Hancflin CadeorW4s9es,�istedAboe, <br /> g � xt <br /> .. <br /> d <br /> -0',`s <br /> 77 <br /> 4Y a <br /> � ,9 ��pq t � sem .• 'edr � � �,��rr�§'��-;�s,"�'�'-��5, x <br /> a <br /> Z 1$r petrol Handling Instructions and Additional Information At� . PROTECTIVEA M • <br /> 0 - p & CONTACT! <br /> C s." S "80�"��d� 9 00• � � tS. ����TI & �AN TE]tiS [ <br /> W . VA,38533 11B. 1:0733—VA02 <br /> = 11A r <br /> t— <br /> 16. GENERATOR'S CERTIFICATION: 1 her declare that the contents of this consiggnment are fully and accurately described above by proper shipping name and are classified,pocked, <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 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�y� <br /> practicable and that disposal currently available to me which minim <br /> I have selected the practicable method of treatment,storage, the present and future threat to human health <br /> N and the environment-OR,if I am a small quantity generator, I have made fl ood faith effort to minimize my waste generation and select the best waste management method that is <br /> available to me and that I can offordC <br /> ' Signature ��''� r Month .Day year <br /> r Printed Name'. r' <br /> w T 17. Trans orter 1 A 1knowled ement of Receipt of Materials Month Day Year,`""^~ ""`� <br /> R -. Signature - <br /> Printed/Typ€ cylrie. ! g <br /> Lu <br /> LL- 0 18 - sorter 2 Acknowled em n of R�cei t of Materials f Month Day Year. <br /> 0 RT rinted/Typed Name tgn re f .> <br /> Lu E 6 47 <br /> n R <br /> V1 tscre ncyI icatton Space <br /> Z - <br /> F . . , — <br /> A- <br /> I % <br /> L <br /> :o 20'. FacilityOwner or Operator Certification of receipt of hazardous materials cover this a est except as noted in Item Month Day Year <br /> TT Printe /Type Name Sign ure t t 4 i t�.i ^^1 <br /> 10 TD <br /> DO NOT WR E BELOW TH S LINE. <br /> {' Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> (Generators who submit hazardous waste for transport out-of-state, <br /> DTSC 8022A(1/99) _ produce completed copy of this copy and send to DTSC within 30 days.) <br /> EPA 8700-22 <br />