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Stale of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30.99( f .See.In 1 Cl+Ctlgti5 on bacwWage 6. Department of Toxic Substances Cor <br /> Please print or type. Form designed for use on elite 112-pr pewriter. - r i '( '5 161 Sacramento,California <br /> UNIFORM HAZARDOUS L Generator's US EP)`,ID No. _ Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST ! t. 2 4 1 of 1 <br /> 3. Generator's Name and Mailing Address A. State A4anifeif.Document jJurtfber 918-3 <br /> /*eua�(/�1/�� <br /> I H ;1'A PI-All tom' t f <br /> 8S. S PAN I:31 VJ a �.t�.w''`(` e. State Generator's ID-- � v <br /> � <br /> l ^ 4. Generator's Phone lJlCilci'l�.ih rE. �14.3ti, + GJJ } �}; { <br /> r' r fs23 <br /> sN 5. Transporter 1 Company Name 6`. US EPA its Number C. State Transporter 3 JD a rve t <br /> 00 .e.. <br /> f' p q D. Trans rter s.P.hone 4i,g ry <br /> 11-49t CP 7. Transporter 2 Company Name 8. US EPA ID Number E. $fate Tran�pQrfer s 1D erved . vF-�« •. <br /> r Yf.S <br /> ell <br /> Q F. Transporter it.rhone -LL <br /> V 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State FaG`t a'1D <br /> Z !... C,G,i a LLL} > - f P" ,[I t• <br /> H. Facilty s Phono w a <br /> Q - 12. Containers 13. Tota 4 'Un-. <br /> V 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> Z o No. Ty a Quantity Wt/Vol I Waste Number <br /> WASTE if)GI iia HYDRUX:{GE SOl,lUT-011 S (IN' 24 ?GII RQ(0462) <br /> NE G e✓ Z:I f 01 15 G <br /> o°Do E 16. <br /> -1 r <br /> N R EPA/Othe ^-+ <br /> o T c tat* <br /> a0o O <br /> R <br /> 0c K. <br /> w d. <br /> ZLU <br /> �S'ctaM <br /> V) J. Additional Descriptions for Materials Listed Above K., Handling Codes;for Wa te;Usfsrl Above r <br /> SODIUM HYDR.OXWE SOLUTION - iAT12-3 (I) ���;` <br /> a / E <br /> w "v6�tt�' yT. iii <br /> aC <br /> O 15. Special Handling Instructions and Additional Information <br /> Z sr...- , tUr6, } +lid+„`r tf: lt,ii;'ilifit'. s'it>rii;Btiti7 3r.5PO.rS!' !'ifJfii {@U�; 5117-1E5i. <br /> w <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> V marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> J <br /> -r If I am a large quantity generator,I certify that I have a presgram in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be economically <br /> in predicable and that I have selected the practicable method <br /> ,Tom <br /> storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> and the environment;OR,if I am a small quantity generator,I have mode a good faith effort to minimize my waste generation and select the best waste management method that is <br /> ck: available to me and that I can afford. <br /> O <br /> UPrinted/1T 4 ame SIg otu a!`) Da Year <br /> C r lJonth T 17. Trans orter 1 AcknowledR ement of Recei t of Materials T <br /> WA Printed/Typed Name Signature <br /> N Year <br /> Month Day <br /> WS !y r✓`.,f /G� L.. r - .....� <br /> 14- <br /> 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> Printed/Typed I ed Name <br /> W YP Signature Month Day Year <br /> w p <br /> Q <br /> V 19, Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> L <br /> 20. Facility Owner or Operator Certification of recei t of hazardous materials covered'by this manifest except as noted in Item-19. <br /> T Printed(Typed Nome Signature L / <br /> M <br /> Y <br /> j'onth D Year--' <br /> DO NOT WRITE BELOW THIS LINE.. <br /> DTSC 8022A (1/99) <br /> EPA 8700-22 <br />