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0 State of California—Environmental Protection Agency <br /> arm Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back of a b. Department of Toxic Substances Control <br /> ,ease print or type. Form designed for use on elite(12-pitch rifer. Sacramento,California <br /> i 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS is not required by Federal law. <br /> d WASTE MANIFEST ® 7 6 5 1 I?� of T <br /> 3.. Generator's Name and Mailing Address A. State Manifest Document Number <br /> l { 20065259 <br /> S. B. State Generator's ID <br /> Ie <br /> A. Generator's P one ( s <br /> t` , J= FIJI=, <br /> CV 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> to <br /> 00 <br /> ROKIO C ERVIROMTAL • 9 4 11121 S 51 7 D. Transporter',Phone ( ) <br /> O <br /> op 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] <br /> F. Transporter's Phone <br /> U 9. Designated Facility Name and Site Addre6or 10. US EPA ID Number G. State Facility's ID <br /> NJ Iz <br /> 1C 11� AL P� - -)bb-42,4 <br /> r= 1 SAT C A a 0 9 4 5 2 6 S H. Facility's Phone ( )324"1 <br /> o EAST PA ALTQ f� 5-4'03 <br /> —' 12. Containers 13. Total 14. Unit <br /> ��V 11. US DOT Description(including Proper Shipping Name,Hazard Class;and ID Number) No. Type Quantity Wt/Vol I. Waste Numr <br /> .V Z a. 1 State <br /> 21 <br /> t= EPA/Other <br /> G li-E 7 127 P :� � 1 W1 <br /> N Eb. A State 214 <br /> C> N <br /> a, E EPA/Other <br /> -4 RDIM C14 AState .J <br /> hfl E 124 <br /> �. 1 <br /> C. R.O.S. <br /> 512 <br /> 66W <br /> 000 O t 1 • / /V, EPA/Other <br /> R Prflf E 1247 128 b / KIN <br /> LU d. <br /> State <br /> w - EPA/Other <br /> U <br /> J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> Un 11ill, VA Cadat DO FM FM a. b. <br /> C. d. <br /> J <br /> Z <br /> E111:1111:1111701 REWLESE 1: (23233-J13" <br /> 0 15. Special Handling Instructions and Additional Information ° <br /> Q <br /> Z <br /> W <br /> Z <br /> 16. GENERATOR'S CERTIFICATION: I herebydeclare that the contents of this consignment are full and accurately described above by proper shipping name and are classified,packed, <br /> Vmarked,and labeled,and are in all respcts 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 treatmvmi,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> N and the environment;OR,if I am a small quantity generator,I have made o g'accl,faith effort to minimize my waste generation and select the best waste management method that is <br /> ad available to me and that I can afford. ✓ \ O `j <br /> OPrince ed Name ` Signature r /° Month Day 0Yeearr <br /> wT 17. Transporter 1 Acknowledgement of Receipt of Materialsell -All <br /> UR <br /> p Printed/T ed Na a Signature Month DayY ear <br /> LU P <br /> U_ 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> 0 T Printed/Typed Name Signature Month Day Year <br /> LU E <br /> U) R <br /> (Q) 19. Discrepancy Indication Space <br /> Z f <br /> A <br /> — C <br /> 1 <br /> L" <br /> f 20. FacilityOwner or Operator Certification of receipt of hazardous materials covered b this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> blerem Evolm: E IN835MDO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />