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State of - Protection Agency .. <br /> Form 8 No..2050-0039(Expires 93494) See Instructions an back of page 6. : D.P.*—*of Toxic Sab.,a,cR.C,or,el <br /> lease print or type. designed for use ae elite(12pdah)"w .Socramerooq Coifoaio <br /> 1. G, Ws US EPA ID No. Manifest Document No. 2. Pope 1 Information in the shaded crew <br /> UNIFORM HAZARDOUS y}, <br /> is not required by Fades law. ..1. <br /> WASTE MANIFEST CAL 0 0 01 11 11 11 61 81 8 Q 1 01 0 0 4 1 of 1 <br /> 3. Generator's Name and Mailing Address Zuckerman-Mandeville, Inc. <br /> P.O. Box 487 <br /> r` Stockton, CA 95201 <br /> in 4. Generator's Phone ( ) <br /> (209) 464-815S <br /> S. Transporter 1 Company Name 6. US EPA ID Number <br /> Falcon Energy Associates CAD 19131215121 6181 51 7 . <br /> J <br /> J 7. Transporter 2 Company Name 8. US EPA ID Number <br /> 1• <br /> 9. Designated Facility Name and Site Address 10,US EPA ID Number <br /> Z Statewide Zavironmental <br /> 12618 Main Street <br /> Los Angeles, CA 90068 CAD 0 0 0 0 18 1 8 1 2 5 2 � ' �1 <br /> .7 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number No Containers 13. Total 14. Unit <br /> P ( 9 Pe PP 9 ) <br /> - No. Type Quantity Wt/Vol <br /> 161aste ?esticides, Liquid, toxic , n.o.s. , <br /> G (pentacrdoronitrobenzene) 6.1, U12902, PG II 0 0 1 D IM O 10.101011 G <br /> E <br /> N b. <br /> E <br /> R <br /> 6 A <br /> o I T C. <br /> O <br /> R <br /> Z d. <br /> w <br /> - t <br /> (Z1 }15. Special Handling Instructions and Additional Information 24 Hour emergency response number 1 (800) 399-4357 <br /> 1lk". <br /> wl <br /> 16. GENERATOR'S CERTIFICATION: I heresy declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international laws. <br /> l <br /> .i If I am a Forge quantify 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 <br /> J economically practicable and that I hove selected the practicable method of treatment,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 enerator{ I have made a good faith effort to minimize my waste generation and select the best <br /> 1 waste management method that is available to me and that I can afford. behalf Of Zuckerman-t-andev <br /> (� Printed/typed Name Signature h- /yanfh �., Day Year t- <br /> T 17. Transporter 1 Acknowledgement of Receipt of Materials U <br /> u R <br /> u A Printed/Typed Name Signature Month Day Year <br /> CL <br /> w rr' r - <br /> 0 18. Trans rter 2 Acknowledgement of Receipt of Materials <br /> 1. R Printed/Typed Name Signature Month Day Year <br /> u E <br /> ( R <br /> w 19. Discrepancy Indication Space <br /> Q F <br /> A <br /> G <br /> s I <br /> L <br /> l 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature I Month Day.- Year <br /> DO NOT WRITE BELOW THIS UNE. <br /> I = 8022A (7/92) J <br /> E 8700-22 green! HAULER 7ETAINS <br />