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State of California—Environmental ProtectiomAgency p Form Approved OMB No.2050-0039(Expires 9-30-99) ee Instructions on back of sage 6. Department of Toxic Substances Control Please print or type. Form designed for use on elite(12-pitch) iter. Sacramento,California UNIFORM HAZARDOUS I. enerator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas is not required by Federal law. WASTE MANIFEST ,, f; ':i I b ". rt i R.l of i. 3 Generators Name and Mailing Address A. State Manifest Document Number s sa aI r e r cwt 3 ;+ s_e ra L x 2, r1vt.,Sl]) 0- 9-`-5205 B. State Generators ID A. Generator's Phone �liQ t� �N 5. Transporter 1 Company Name 6. US EPA ID Number C, State Transporter's ID[Reserved.] CP { gq 0 x:isa dal@'93..t,�,.L l°..�.t,�, r:a7.e ..t,s` f s ';,`.i �:) '; r,1 ..1 ai D. Transporter's Phone @'C)I,B f t. ..lt 4 7 7. Transporter 2 Company Name 8 .:. _ e P P Y 8. US EPA ID Number E. State Transporter's ID[Reserved.j J J Q F. Transporter's Phone V � (r tm.Adress y 10. US EPA ID Number G. State Facility's ID Z .rLj�lz t- tri b' j"`� `s +r`�I �. �.�.� �r i d4 t E.'sr� r✓ H. Facility's Phone yp O F� �.a' t 15 ✓ _ _,s t i. tq:#•t l ..d g S. .S„d hR,<r'fr Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Nuinber 12' Containers 13. Total 14. Unit V P� ( 9 P PP 9 ) ,+ No. Type Quantity Wt/Vol 1. Waste Number Z a d.s....&` t`�,5.^ii%° >2 _u s`'?�.p i.? .« x 'F:i,It r ?,. Z .�� L.da z r�<.R`�.....„, State 3 E k of l.y win t t' EPA/Other b. 0 N oo E State N R EPA/Other V A o T ` 0 ® State R EPA/Other u-t d. I- Z State w V EPA/Other w Z1N J. Additional Desc'ptions for ateFials Listed Above q K. Handling Codes for Wastes Listed Above J c. d. Q 15 pp$yp; iql HQ,ndli gn`sptructions and Additional Information p O , IR Ili L i II.i YJJ.,; f'#Lr'f Zsif'; 14 :t .4t , itI. afsS o ®r`.'; _ie = 10 w 2 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, V marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. J Nand- 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 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 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 0C available to me and that I can afford. O } Printe�/Typ@O Name Siinpture Z / mow) Ij Month Day Year. LU (5 R 17. Transporter 1 Acknowledgement of R cei t of Materials p Print /T ed Name17 w YP l t(' Signature I `R I ! L.* ] Y 1 7 1 l I I t i i t{{Month, Day Year u l P V'a+-9 w t kt k. -s' ..E `�te,1 rf�r� A�C ft+ e i I i `;,ij Ss / t... U- B 18. Transporter 2 Acknowled ement of Recei t of Materials V 9 0 R e E Printed/T Printed/Typed Name Signature Month Day Year w N R Q V F 19. Discrepancy Indication Space Z A C L I 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. T Printed/Typed Name Signature- g Month Day Year DO NOT WRITE BELOW THIS LINE. DTSC 8022A (1/99) EPA 8700-22 Yellow: GENERATOR RETAIivS