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nia—Environmental Protection Agency d� l 16307", <br /> " <br /> *v OMB No.2050-003 'Expires 9.30-99) '`tr '' SeeAnstructions on back of g@ 6. Department of Toxic Substances Control <br /> type.- Form designed for use an elite(12-pjJt if r. Sacramento,California <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 is not required by Federal law. <br /> e «3. Generator's Name and Mailing Address 1 .1 <br /> . ntfeft 15ocument N,­ <br /> 1029 <br /> nh� �fylw��I/a�gt{�1y� N <br /> lrlt " � N!'rf2 1! <br /> LO enera A,P one( j- I �" ... <br /> tt q h,, s <br /> N 5. Transporter 1 Company Nome 6. US EPA ID Numbert T' nLn <br /> s TCS eserved yµ <br /> _ S�. k 'fir* •• `z..,, �' " < <br /> CD FAN RATERS ROM" 1W <br /> - =tri + <br /> (" CD4 421515171 A <br /> f} � 03 � "a <br /> o0 7. Transporter 2 Company Name 8. US EPA ID Number t: �cttFb Ftfsspct®p'a1Q Resewed j s >ti ° ' r <br /> VIV14 R rt2.5 INCc+ r <br /> —' yy�� nr� 0rqy 0n n n j ,F �Trnnsporter^ Pftone", <br /> Q t,. d'S 1.T rJ V � L ..� 9.7 � � 9 l <br /> -49. Designated Facility Nome and Site Address 10. US EPA ID Number fs Stateicfty`4 tD t " <br /> Z SZSTECH �;Y�IVIRt TALC I,:N m <br /> 'Box 111 <br /> O SOUTH CEIa dT RG I�_ � � Ph� <br /> U 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12, Containers 13 Total 14. Unit <br /> No. Type Quantity Wt/Vol 1 Waste Number <br /> Za.Rt r WASTE PP.INT UD HATERTAt, !.State M �ar kA� <br /> 3r 263,r PG 11, ( 190)r (EPA P003, D001), r } <br /> 3 G (MG 127) �PA/tather r"r � 'r <br /> E � <br /> o N 6' sty 00 x <br /> 00 <br /> E � <br /> N R <br /> C.OD 0 <br /> 5igtett „ T h ` <br /> R EPA, <br /> /Offter <br /> LU d. <br /> Z <br /> w <br /> J.Additional Desch harts forMatenalslistsd A F' tu � "'"qt a it <br /> ' �.' F � 5* s s 1 :1fartdffitg OCdes ftiT Waste <br /> s fisted Above <br /> '�" 'r2� L :..� „�' �,„�,s.'ae t •f.,h atF�N,��., .� -C�"" NNW <br /> 1t T� ,,.. r c ` ft <br /> W - - <br /> n <br /> r \ YiG <br /> O +r� RLA'R APPROPRIATE PROT=I . <br /> 15. Sgpgeeia{lEH{�andlinglnstruetions�asndAdditiona�lpinformationq gy�e�y �g grypy CALM <br /> . /fin g ;r�t�@t�r�yT � <br /> Q .. {4VS.tt�t'a.Y M ACTT 't.P, XCt... ,1.^^'800-4Lb4^9. 00— M sSaY? ` .A. A'3 •._fAN @W'l.dE'sps �t <br /> Z R '5 AS SKIPPER. <br /> LU 11A. GA10733-VA02 <br /> t— <br /> Q16. 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 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 economically <br /> CL. 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 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 /> O <br /> available to me and that I can afford. <br /> Printed�ed Nom® f�,..+• /� Signature Month Day Year <br /> w T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> It <br /> LU A Printed/Typed Name Signature Month Day Year <br /> LU <br /> � R , <br /> U- 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> O T Pri ed/T d atpe Signa - - Month Day Year <br /> LU E <br /> UF 1 . Discrepancy Indication Space j9 <br /> Z F <br /> — A <br /> 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T <br /> Printed/Typed Name Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) White: TSDF RETAINS <br /> EPA 8700-22 <br />