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State of Cal ifor..nia—Environmental Protection Agency <br /> Fo pproJ d OMB No.2050-0039(Expires 9.30-99) See Instructions On back Of a 6. Deportment of Toxic Substances Control <br /> print or type. Form designed for use on elite(12-pitch)Fifer. Sacramento,California <br /> 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> UNIFORM HAZARDOUS Z 9 .� of is not required by Federal law. <br /> WASTE MANIFEST <br /> 3. Generator's Name and Mailing Address A. State Manifest Document Number <br /> S. B. State Generator's ID <br /> LO i <br /> A. Generator's ( e J= RMM <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> 00 <br /> O RWC EUEMEMAL TM. 11 11 11 4 111116151 7 D. Transporter's Phone f 1 -1 <br /> O <br /> co 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] <br /> F. Transporter's Phone <br /> Q <br /> �q U 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> m 'Q D It 11111451 71 <br /> .Z RMIC EWTERNMAL 74M H. Facility's Phone <br /> 2081 5A7 ROAD A U a a 9 4 5 2 6 5 7 (M)324-MN <br /> UST PALO dl.Tf <br /> 12. Co <br /> � ntainers 13. Total 14. Unit <br /> V11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol (. Waste Number <br /> NZ --VAM PAW REIATED UTERIAL 3 U11263 $1 State <br /> S <br /> 3 G EPA/Other <br /> Prfl# 1 127 <br /> O N b' 3 - State <br /> 00 <br /> E EPA/Other. <br /> CN A 1# E 567 127 Uzi t 1 <br /> o T c' state <br /> � <br /> ® EPA/Other <br /> R Prfl# E 34 129 f0101 V 914 1 <br /> F LIVUI1Wj ill FUNIRKE J LIN <br /> state <br /> d.{ I . <br /> vPri1 $ 1247 1289 r t FPA/Other, <br /> J AddittX11 D r' tjpng for� "M s ' Above K. Handling Codes for Wastes Listed Above <br /> Su �� ttrrWAT3 a. b. <br /> 41.E_ # <br /> LU <br /> c. d! <br /> J A / <br /> Q <br /> Z 15. Special Handling Instructions and Additional Information <br /> O ' <br /> Q <br /> Z <br /> LU <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 clossifi ed,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 /> -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 hove determined to be economically <br /> Pi 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 /> 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 /> a' available to me and that I can afford. <br /> OPri yped Name /r Signature Month Day Year <br /> 010 <br /> 10 1 <br /> ty T 17. Trans orter 1 Acknowled ement of Receipt of.Materials _- - :4 <br /> R Signature Month Day Year <br /> w p Printed�Yyped Name C <br /> 1 0 10 <br /> LL- B 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> TPrinted/Typed Name Signature Month ay Year <br /> LU E <br /> Q R <br /> V F 19. Discrepancy Indication Space <br /> Z A <br /> - C <br /> l <br /> 20. FacilityOwner 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 /> xeteream rte: E WN3MDO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />