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State,of E,IiforAia�Envirot mental Protection Agency.," <br /> BQrm,(approved OMB No.2050-0039(Expires 9-30-99) SQe Instructions OA E1®Ck Of R` @ 6. Department of Toxic Substances Control <br /> A. <br /> Yteasc p.int or type. Form designed for use on elite(1 Z,pitch/ iter. Sacramento,California <br /> UNIFORM HAZARDOUS 1ment. enerotor's,US EPA ID No. Manifest Docuo. 2. Page 1 Information in the shaded areas <br /> is notrequiredby Federal law. <br /> WASTE MANIFEST A IIA 10 10 10 fi <br /> 9. Generator's Name and Mailing Address A. State Manifest Document Number <br /> � <br /> B 'ER <br /> 44 3"I , <br /> - 40 4034 <br /> 4 E CT # <br /> B. State Generator's ID <br /> T CKTON � CA %215 <br /> LO 4. Generator's Phone ( ' <br /> N 5. Transporter 1 Company Name '- b. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> h �yy+ <br /> 00 AS RY NNNI ON I IAL SER`�CE'S 1✓ A U O ;a '� D. Transporters Phone 9 4^ <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] <br /> QF. Transporter's Phone <br /> U 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> g 01 K-ENIARONP&ENTALC ( U <br /> Zmce 366A EkQT 26TH STREET H. Facility's Phone <br /> L OS a° c ,�: A ' 0 8 3 B . <br /> Q _ 12. Containers 13. Total 14. Unit <br /> U 11. US-'DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol I. Waste Number <br /> Z a. State <br /> 35 <br /> Z C)US WASTE L.I D, .O.S,9,1 IIS 1 <br /> 3 G i EPA/Other <br /> E b. ar����, t�, t�: -gyp t�, P+, p�,c r <br /> 0000 E NON RCRA HAZARDOUS WASTE SLr1.IV l®ILS SOL€€�S':� state <br /> n►+1f 1T�add I EPA/Other <br /> A ltlit^t?1 r diLiiL11 7 i!' L N <br /> T 1+�ICELES, CALIF or HAS THE state <br /> 00 R ' 'PROPf�IATE P RMITS TO RECE <br /> EPA/Other <br /> LU d, v-1A State <br /> �, NUMBER IS CAT080033&81 <br /> EPA/Other <br /> W <br /> N J. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> Z ' <br /> a. b, <br /> Ce lq�X LU X _ a. T,ATF ��{o <br /> j C. d. <br /> J <br /> Z <br /> 0 15. Special Handling Instructions and Additional Information <br /> aUSE <br /> PPE <br /> q R q y h g 171 q EW NCY CONTA OT: HE EC 14300-424-W <br /> Z 't`SG I A 19 d, a 1B. 77 i <br /> LU <br /> 16. GENE TOR'S CERTIFICATION: I here y declare that the contents of this consignment are fully and adchi'dtely described above by proper shipping name and are classified,packed, <br /> U marks ,and labeled,and are in all respects in proper condition for transport by highway according to applicable i*rngtio <br /> To <br /> and;lipfional government regulations. <br /> 1 <br /> If I.'am a large quantity generator,I certify that I have a proyrom in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> V 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 /> N 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 /> O <br /> } P,ed/Typed Name at Month Day Year <br /> w T 17. Transporter 1 Acknowled emen f Receipt of Materials <br /> wR d <br /> A Prin d/Typed Name Signature Month Day Year <br /> 019 Iniqw <br /> LL p 18. 'Trans orter 2 Acknowled+ement of Receipt of Materials <br /> TPrinted/Typed Name Signatur& Month Day Year <br /> LU E <br /> R <br /> U l19. Discrepaannc®yIndication Space <br /> I <br /> Z A Ilk S �a ,ia, i D✓ 5� 'naa t= <br /> L <br /> 120. Facili r or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Ty a ams Signature Month Day Year <br /> Y C-) <br /> DO NOT WRITE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A(1/99) (Generators who submit hazardous waste for transport out-of-state, <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) <br />