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State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires'9-30-94) See Instructions on back of F 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite(12-pitch)type—ter. Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFESTof is not required by Federal law. <br /> 3. Generator's Name qad Mail' ddres A State Manifest Document Number ' <br /> S�ac, �- �„ATi�G �-� 92448241 <br /> 63= S. E� tJoR�+� I'* stateClinaratols ID <br /> 04 Ln <br /> 4. Generator's Phone <br /> pp cis ` / / O lllTTT <br /> Op 5. Transporter 1 Name Company N 6. US EPA ID Number C. State Transporter's ID <br /> %�� i <br /> 111✓;r <br /> . -��i, -e <br /> 1 0 9, x 2el 6i D. Transporters Phone Rte' y�— <br /> J <br /> J 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporters ID <br /> F. Transporters Phone <br /> C9. Designated Fociliy N me and Site Add ess 10. US EPA ID Number G. State Fodlity'-42 s <br /> OQr �,1F°�/G91 l��sif/f1�►yt9 E�lr=,��/�-c � (; � <br /> 33 f2 (f-lc� sX%�- .�D H. Facility's Pho <br /> �lclT �t�,Y G�j CAT e ci / 7do <br /> e711 <br /> 11. US DOT Description(including Proper S ipping Name, Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit <br /> a. <br /> No. T e Quantity Wt/Vol 1. Waste umber <br /> y� Aec sit- o �!�s y State <br /> 3 G �A �09� _ EPA/Other <br /> E <br /> 00 N b. state <br /> 00E <br /> � R EPA/ <br /> v A <br /> T C. State. <br /> 00O <br /> C <br /> R EPA/Other <br /> LU <br /> ~ d. State <br /> Z <br /> U EPA/Other <br /> w <br /> v <br /> Z k Additional Delaiptions for Materials LWV Above K. handling Codes for Wastes Listed Above <br /> ° 57� . . a. b. <br /> .- <br /> w . ';� <br /> O 15. Special Handling Instructions and Addinal Information <br /> H <br /> Q <br /> Z <br /> LU <br /> 2 <br /> J 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> Qpacked,marked,and labeled,and are i�all respects in proper condition for transport by highway according to applicable federal,state and international laws. <br /> U <br /> If I am a large quantity generator, I cel tify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> J economically practicable and that I have selected the practicable method of treatrpent,storage,or disposal currently available to me which minimizes the present and future <br /> 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 <br /> � <br /> waste management method that is available to me and that I can afford. 4 <br /> O Printed/ yped Name Signature Mont Day i Ypar <br /> U T17. Transporter cknowled ement of Recei t of Materials <br /> W R <br /> n Printed/Ty Name Sig re Lam' Month Day ear <br /> LU 5 ,•tSG�/� /�G',r-�'/pt�9 ��'-!�-moi / �rs� f9' �� <br /> LU -_ <br /> 0 18. Transporter 2 Acknowledgement of Recei t ofMaterials <br /> LU R Printed/Typed Name Signature Month Day Year <br /> U- E <br /> O R <br /> LU 19. Discrepancy Indication Space <br /> N <br /> Q F <br /> U A <br /> Z—i C I <br /> L <br /> 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> Printed/Typed Names Signature Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (7/92) <br /> EPA 8700-22 Yellow: GENERATOR RETAINS <br />