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J0/26/`00 12:25 e209 953 4762
<br />"State. of Cohforn,a—EnvlronnMntal Protection Agency
<br />Form Approved OM; No 2050-0039 IExpires 9.30-991'
<br />please print or type form dcsiarred for use on ef•re (I2-poch) ry•txw, cr
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<br />SUSD FAC PLANNG Q 003/003
<br />See Instructions on back of p6. Departmont of Toxic Substances Contrc
<br />Sacramento. California
<br />VU NUI WKIIC DCL%JYY PB -,IJ
<br />y,'r`:r:: ......F SEU405 THIS COF`• T:1 GctJF,4'Csc WITHIN DAY--
<br />15�cnerators who transport out-ol-stab..
<br />DTSC 8022A (1/99( pro:iuca completed copy of ;kis copy ;inri send la DISC within 30 days.%
<br />EPA 8700-22 -
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<br />t Generator's US EPA ID No. mori,fe
<br />i DOcuar,erl No.
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<br />Information in the shaded areas
<br />UNIFORM HAZARDOUS
<br />is not required by Fedora) law
<br />WASTE MANIFEST
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<br />3. Generator's Name on Mnil,n? A&LI.15
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<br />A. State Manifest Doeume f Number
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<br />B. State Generator's ID
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<br />4. Generator's Phone I ;l,. i•; tis ,-r.+
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<br />/ 5 EPA ID Number
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<br />5 Transporter 1 Compo
<br />D Transporter's Phone
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<br />8. L'S EPA ID Number
<br />E. State7jansporter Is AD [Reserved.) J_
<br />7 Transporter 2 Company Name
<br />f. Tronsparter's PhOn®
<br />9. Des�gnot}0. US EPA ID Number
<br />ed Facility Nome and Site Add,ess
<br />G. State facility's !D
<br />H. Facility's Phone
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<br />12. Containers
<br />Unit
<br />13. �Wt/vol
<br />11, US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number)
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<br />Type Guomber
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<br />Handling CadeAbove .:
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<br />15. Special Handling Instructions and Additional Information
<br />witftla: [V�ifiC:#219
<br />`f wsLf{ i3J fZ E tNJ�"#f I1iSi. 24 HOUF emergia' c,t,
<br />1r3faLmr pit f)vef ptote;,'GI-tvl fItIr.iltlfb'ent .
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<br />16. GENERATOR'S CERTIFICATION: I hereby declare that Ike contents of this consignment are fully and accurately described above by proper shipping name and ore classified, packed,
<br />international and national government regulations
<br />marked, and labeled. and are in oil respects in proper condition for transport by highway according
<br />to applicable
<br />If I nm o large quantity generator, I certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I hove determined to be economically
<br />if I a a disposal currently available to me which minimizes the present and future threat to humon health
<br />c le one that I hove selected Ike practicable method of treatment, storage, or
<br />I have mode a good faith effort to
<br />minimize my waste generation and select the best waste management method that is
<br />and the environment; OR, if t am a smotl quantity generator,
<br />ovoi}able to me and that I con afford
<br />Month Doy Yenr
<br />T ed Name Signature >
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<br />Tns rter I Acknowledgement of Receipt of Materials P
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<br />Month Day Year
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<br />Printed/Typed Name - Signature
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<br />18. Trans orter 2 Acknowled g omen o{ Recei t of M teriols
<br />Month Day Year
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<br />Printed/Typed Nome
<br />Signature
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<br />19. Discrepancy Indicanon Space
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<br />20. Facility Owner or O erator Certification of recei t of hazardous materials covered 6 This manifest except as noted in Item 19. Month Day Year
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<br />VU NUI WKIIC DCL%JYY PB -,IJ
<br />y,'r`:r:: ......F SEU405 THIS COF`• T:1 GctJF,4'Csc WITHIN DAY--
<br />15�cnerators who transport out-ol-stab..
<br />DTSC 8022A (1/99( pro:iuca completed copy of ;kis copy ;inri send la DISC within 30 days.%
<br />EPA 8700-22 -
<br />2`t 0F
<br />
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