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-. y(Form designed for use on N' -2-pitch typewriter).* Sacramento.Glilorn. <br /> ORM HAZARDOUS Generator's US EPA ID.No." Z Man:.oa 2. Page 1 <br /> Documennto oration m ma shaded vacs <br /> t <br /> 4ASTE MANIFEST '? aI O :- 1?1— '/111 gl Is not required by Factual law. <br /> rator'a,Name/u?f� y,nd McJJ�II g Address A. Slate Manllest Document Number <br /> dl.n f.Tt <br /> 9807024 <br /> �J'S 1 8..state Generator's ID <br /> ,4. Generator's Phone <br /> 6. Transporter 1 Company Name S. US EPA ID Number C. State Transport's ID ,. ! •]'/ <br /> / J / <br /> _.` / —1<' D: Tranaportara Phone '�y J•j - ,0 0 <br /> 7. Trancponer 2 Company Name 8. US EPA ID Number E. State Transponer's W - <br /> _. a �' /` r,"y / .�. F. Tnnsponer'a Phone:: <br /> 8. D ipnatfod Facllit Nome and de •dre 10.. US EPA ID Number G. Slate Facility's ID <br /> t P/;J€ /�5v � <br /> r'A rr,- MCA <br /> o N IL Fac41ty'a.Phortr <br /> U � <br /> < : 3 '114. 1 -17'r,-,1/ 1 7 i 10,j <br /> 12. Contalneta 13. T-a <br /> 0 it. US DOT Description(Including Proper Shipping Name.Hazard Class.and ID Number) Osssil Urdt No. <br /> Q J No. Type oI <br /> 'coU .. .. I :.i�.. , .:, . 1. ; .. , I; C^+- � <br /> �Z- G ENVIR NM, TH <br /> m€ N CES <br /> 3 E b. 'Step,'._ <br /> R <br /> A <br /> T FPAAOIIur <br /> r O <br /> v R <br /> C. 'State <br /> _. ... <br /> g EPA/OUW <br /> W it. StalkF <br /> U FPA/OidW <br /> m J. Additional Desoriptions for Materials Listed Abovs K. Handling Code_s for Wastes Lived Above <br /> Z <br /> c q . d. <br /> z <br /> P15. Special Handling Instructions and Additional Information <br /> Z 24 H:. tam fartcy C014ULCZ; YAC 1 1-0 00-474-4444 <br /> 24 two rwrgw:cy Alapouna: Quw TEL INC. f 1—{ypl3)-29§-3y24. <br /> A??RUI?A1A'PS rdLY=T1Y8 CLci'13ll Q AAD kBali'1AarW <br /> J <br /> J <br /> U <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this Consignment are fully and accurately described above by proper shipping rums <br /> end are classified.packed,marked,and labeled,and are in all respect&In proper wrWltlon for transport by highway according to applicable international and <br /> wnational government rspWedona. <br /> ti If I am a large quantity generator.I cenly,that I have a program In place to reduce the volume and toxicity of waste generated to the degree I.have determined <br /> O to be economically Practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the <br /> present and future threat to human health and the environment;OR,If I am a small quantity generator.I have made a good faith short to minimize my,waste. <br /> U generation and select the beat waste management method that la available to me and that 6can afford. <br /> I W Prntsd/Typed Name - Signature - Month Day Year <br /> X <br /> WT 17. Transporter 1 Acknowledgement of Recalpt of Materials <br /> ZR <br /> < A Printed/Typed Name Signature Month Day Year <br /> UL <br /> w O 18. Transporter 2 Acknowledgement of Receipt of Materials - <br /> 1 U T Printedr Typed Name Signature Mdrlh Day Year <br /> E <br /> 2 <br /> Ip19. DiscrepancyIndication Space _ <br /> 1 F _ <br /> A <br /> C <br /> L <br /> 1 20. Facility Owner or Operatw Certification of receipt of hazardous materials covered by thl • s except as noted In hem IQ., <br /> T <br /> i y Printed/Typed Name I Signature .1 Mont Yes, <br /> ! jj <br /> DHS 6022 A(wall) Do Not Write Below is Line - <br /> d EPA 8700-22 <br /> (Rev.9-88)Previous editions are obsolete. <br /> GREEN: HAULER RETAINS <br />