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e <br />State of California-Environmental Protection Agency .--- j 'i <br />F?-4 Ailproved, OMB No. 2050-0039 (Expires 9-30-99) See Instructions On back of@ 6. Department of Toxic Substances Colt a ' <br />P19lse <br />print <br />or type. Form designed For use on elite (12-pitch) Ater. Sacramento, California <br />UNIFORM HAZARDOUS <br />1. erator s US EPA ID No. Manifest Document No, <br />2. Page 1 <br />Information in the shaded areas <br />WASiEaMNIFE$T" <br />y')" 4 )- 4 <br />�•-u` i .1pa <br />isnot required b Federal law. <br />q y <br />of <br />3. Generator's Name and Mailing Address MAH i �: r q+k <br />.Cl' <br />A" State Manifest Document Number <br />110 , <br />225903 <br />i <br />4 04 <br />1 <br />O <br />=`•3-i "' 55205:'B..•StateGenerator's <br />t . C 1 C-A,,{ <br />ID - - <br />u7 <br />, <br />A. Generator's Phone ( ; xq �_z�`'46-•`3746' <br />rc <br />h <br />CV- <br />.5. Transporter) Company Name - - - 6. US, EPA ID Number - <br />C. State Transporter's -ID'[Reserved ) <br />00 <br />_ a i #�I _ _ , . � k t <br />_ <br />; <br />D. Transporter's Phone <br />6 74,,'t <br />fi <br />k^ <br />7. Transprr r 1161pany Name 8. US EPA ID Number <br />E State Transporter's ID [Reserved.) <br />I� <br />b U <br />f. Transporter's Phone <br />9 . Desi noted Facili Name and Site Address " + L 1 __,t •- <br />g Facility 10. US EPA ID Number <br />G. State Facility's ID <br />� <br />'rZA_ <br />bZ <br />10 <br />;, a n s C "'}c3; r sR; � ci .x <br />H. Facili 's Phone <br />L <br />w <br />i <br />_u- <br />V <br />11. <br />: US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />Quantity <br />14. Unit <br />Wt/Vol <br />1. Waste Number <br />No. <br />Type <br />Z <br />z <br />a <br />t t .tet, C:L a k a 4G .,0I1i-"(,S JND . 1 B. N <br />DIn <br />_ <br />•� <br />State <br />i <br />G <br />t��N. gC <br />1.. • tt ti- r NOTx.1 A 1i!"' l�Ma'! t9 �..:�S :T- i 3..� T <br />fi <br />EFA/Other <br />d .t.st,.3 i? t n °S{ �g WASHER. <br />Aft a..t <br /># <br />o <br />E <br />N <br />_ <br />6 <br />State <br />L <br />00 <br />00 <br />R <br />EPA/Other <br />T <br />c• <br />State <br />00 <br />R <br />R' <br />+- <br />EPA/ Other <br />tw- <br />d. <br />State <br />i <br />Z <br />l <br />Lu <br />U <br />h <br />EPA/Other ' <br />{ <br />L <br />ZJ <br />AddihonafDescrtpt+ansfar Materials Listed'Above <br />K. Handlis for YVastes listed Above <br />) <br />p <br />6.a <br />Lj�6i�e <br />1 <br />a <br />Z <br />15 S ectal Handlm Instructions? and Additional Info 1 1 >'? s ?rt <br />t Lf 3, 6. #3t' a ,. _ 1s <br />4mation <br />60 <br />p <br />Q <br />Z <br />{ <br />16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurate)y described. above by proper shipping name and are classified, packed, <br />Vmarked, <br />and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government eegulati®ns. <br />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 economical]yy <br />practicable and that I have selected the practicable method of treatment, storage, or disposal cvprently availbble to me which minimizes the and future threat to human heplth <br />N <br />present <br />and, the environment; OR, if I am a small quantity generator, I have made 'a good faith eff t6 minimize my waste generation and select the best waste management method that is <br />available to me and that I can afford. <br />Printed/T ed Name <br />yp <br />S nature <br />9. / 9' <br />Mgnth <br />y YeaS.fyuj <br />i <br />311 1c) <br />T <br />T_",Trans anter 1 Ack wiled ement of Receipt of Materials <br />U-1 <br />W,. <br />R <br />.p y <br />/ : ''r9 <br />Pnnted/Typed a/me'rpy3 <br />Ai" <br />Signt� — <br />ri._..-m+p�--_"-. <br />Menj D y Yearn <br />P <br />qs <br />`""`� �. ✓ �4'-�--� '"�•�-'.r'.^' L :'� <br />,d'"uu...�•�. <br />— <br />0 <br />.w..�•� �...de <br />18. Trans orier 2 Ackoowleclement'of Receipt of Materials „ ^' " <br />''._ <br />T <br />T <br />Printed/Typed Name <br />, <br />Signature . <br />Month Day Year <br />ILL! <br />N <br />E <br />R <br />(aj <br />10.:Discrepancy Indication Space <br />ZF <br />-C <br />A <br />1 <br />j <br />L <br />I <br />f <br />20. FacilityOwner or Operator Certification of ecei t of hazardous materials covered b this manifest except as noted in. Item 19. <br />T <br />Printed/Typed Name - <br />Signature - <br />_ <br />Month Day Year <br />y <br />{ <br />i <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (9/99) Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />EPA 8700-22 To: P.O. Box 400, Sacramento, CA 95812-0400 <br />i <br />1 <br />