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State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-99 See Instructions on b of Page 6. Department of Toxic Substances C <br /> t # Please print or type,;„Form designed for use on elite( chJ typewriter. Sacramento,California <br /> i <br /> �1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS <br /> WASTE MANIFEST of s not required by Federal low. <br /> iTM <br /> 3. Generator's Name and Mailing Address A. State Ma�i+fest Daaprt int NutSf er <br /> { LODI FM <br /> hµ 3 <br /> 5 a 3 <br /> 029 S SACIRROMTO ST <br /> � ateeaerat �aa <br /> / ��'g¢ <br /> erator s P one ( ) ��� <br /> 333-3500 RNMR115=011= . am 15 <br /> ;q +,_ - . <br /> 5. Transporter 1 Company Name 6. US EPA ID NumberVM C". Mate TaarfpYerfrdl> 1�eserve"d ti> t r <br /> M•S Px R. S IW" <br /> IC 1A ID 10 1110 19 12 15 15 17 16 k" <br /> D aaan$p# tet1' afea Biu b <br /> a0 <br /> 7. Transporter 2 Company Name 8. US EPA ID Number £1^"date TranSparter ffi qD $ts rvet <br /> VAN wo Q ls! Vit. XtK" A I F E9 13 g 0 i Q F.Txxtnsporter s Phane . , . <br /> U 9. Designated Facility Name and Site Address 10. US EPA ID Number G::State factt s JD <br /> 4r',1`'3TFC,8 VV7f.T?'C*4H `IT'PL t...OPP� 0' .F-A TI.k' <br /> BOX III <br /> .� 1d,.�araftty'sT'hotae � '- «r, <br /> OUTR CEMENT ROAD <br /> l MEEKV c1 �a 7 <br /> J <br /> Q 12. Containers 13. Total 14. Unit <br /> U <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) .� <br /> No. Type Quantity wt/vol 1,vs+'aste Number t <br /> 3, M1263, PG 11, (1��,}�1E�U}, (XPA <br /> u <br /> E Db <br /> CN N b�, PAINT RELATED MATERIAL Awl� <br /> o E 3, ,26.3, PG ]Cls (RO-100jr (EPA IXJ03,. ��:� d�`�., �1� � <br /> v R (ERG 127) � <br /> d A <br /> �x <br /> p T C. '�., '�� , , <br /> OCD <br /> ao O ' w <br /> Rce �` <br /> d. 5v ; <br /> W t <br /> W <br /> N, t3 1s}gi'uraa{crf3diaterip; s9eAp a� �` r t , xt K HondlingCodes for) cstes Lstad Above <br /> X <br /> Q <br /> 0 15. Special Handling Instructions and Additional Informa.t�ion . A 4 APM0 IATX PRICITRICTIVE <br /> rRAR <br /> M 14 NIrffTN <br /> G4. <br /> H ���° J-3AV"@2g" 9 [( e C ��R pVpJ1p�yRT V Y[qp� iCZE4. V +A LG7ACCT. t <br /> R <br /> I <br /> = 31A.. V'A38533, I.IB. GA3.0733-VA02 <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 /> V marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and not, <br /> 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 /> Npracticable 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 /> and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> ce available to me and that I can afford. <br /> 0 <br /> j } Printed/T d Name �s'J �' Signature1 ,i Month aL Day Year <br /> U <br /> Z <br /> W'. T 1-77'Trans orter 1 Acknowledgement of Receipt of Materials <br /> ck: R <br /> W p Printed/Typed Name Signature Month Day Year <br /> S <br /> L- 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> 0T Printed/Typed Name Signature .} Month Day Year <br /> W E <br /> V) R <br /> Q <br /> U F 19. Discrepancy Indication Space <br /> Z A <br /> _ C <br /> t <br /> L <br /> I 20. Facility Owner or Operator 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 /> DTSEPA 8700-22 8022A (1/99) <br /> EPA Yellow: GENERATOR RETAINS <br /> I . <br /> ........ . <br />