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State of Cali fornio—Environmental Protection Agency <br /> Form Approved 9M8 No.2050-0039(Expires 9.30-99) See Instrulrtions on back ge�.�"� ., Department of Toxic Substances Contrc <br /> I Please oriot or type: Form designed for use on elite(12-pitch writer. - _ - r <br /> Sacramento,California <br /> 41 1. Generator's US EPA IL Nc Manifest Document No. Information,in the shaded areas <br /> UNIFORM HAZARDOUS <br /> WASTE MANIFEST is not required by Federal law. <br /> of <br /> 3. Generator's Name and Moiling Address A. Stole Manifest Document Number Q Q <br /> 44 <br /> lis iVI'A I_AIC <br /> vOi L3 i.v `S,. :i I'"151. U� i ;i 1 VIII L,11 B. State Generator's 1D <br /> n4. Generator's Phone (, ,, 4 s- - -.i, ,W -. ,t• -7{ - <br /> (N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Tronsportels I (Res <br /> W ..,.>e. .... .. .�., ,... :. <br /> o D. Transporties Phono :r' <br /> Ncr C? 7. Transporter 2 Company Namer <br /> 8. US EPA ID Number E. State Tronsporter's ID e ry I <br /> Q F. Transporter i Phone <br /> N U 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State�F(aeil1 IQ k <br /> co Z <br /> 0 <br /> N 0 k)�ji: avow I aIK""I:u Dr F <br /> , ;as'$ H. Fa<ilflys Phone <br /> "- <br /> hh tt J `, lJ <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 2. Co ainers 13. Tot f 4. i '; � y r <br /> Z a. No. T e Quantity Wt/Vol , Waste•Number ' <br /> z "state <br /> 3 G b`�` sna'is wlauA:4 ALsIJ JUaJY'.vjs u JNir3J fvl! � fUf4ct r1k(i(1Jb1 <br /> O N 1Stata <br /> t <br /> oci E rif u,un,t�hlU.: 9AST', ;tai u. X.0,S !UQc; <br /> v R LSi!i 0A/Ck6 <br /> C1`1 A C 03 o o p ;: <br /> p T 4taho' <br /> 0o O r +, <br /> R EPA/Other, <br /> LU d. <br /> wtgte <br /> UPA/Othen <br /> w <br /> J.Additional Descriptions for Materials Listed Above <br /> Z K. Handling Codes far Wastes r fisted Abavo <br /> 0- a) 3J5566-44 J16�'1 - C&C1111IC ACID - �A1�6_g {i) b} �941S3-1I5 ` PiYfi FTLT88CAIE b'' <br /> Sraa ;2) ls1033 <br /> O 15. Special Handling Instructions and Additional Information <br /> BSSPONSE, CALL (323) 776-5233 <br /> Q <br /> z sLA r'?w 6c <br /> oRo' nvF. cLOT. .'IAG, CRERGENCY 6ESPOHSE P,SONE 004) DIS-9911 (775) 575-2777. <br /> W <br /> Q16. 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 /> e! IF I am o large quantify generator,1 certify that I have a pro ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to be econamicaffy <br /> °- practicable and that I have selected the procticable method o�treatment,storage,or disposal currently dvailable to me which minimizes the present and future threat to human health <br /> Iceand the environment;OR,if <br /> 1 am a small quantity generator,I hove mode a good faith effort to minimize my waste generation and soled the best waste management method that is <br /> 0 available to me and that 1 can afford. <br /> } 1iMedZ_Typed Name _ Signature <br /> aMonithaDoi Your <br /> () T 17. Transporter 1 Acknowled ement of Receipt of Materials l <br /> A <br /> W p Printed/Typed Name Si nature <br /> A / g Month Day Year <br /> w v -' J I' <br /> O0 18. Trans orter 2 Acknowled ement of Recei t of Materials <br /> TPrinted/Typed Name <br /> N E Signature Month Day Year <br /> Q .R <br /> V F 19. Discrepancy Indication Space <br /> Z A <br /> — C <br /> I <br /> L <br /> Facility Owner or Operator Certification of recei t of hazardous materials c veredby this manifest except as noted in Item 1.9. <br /> T Printed/Typed Name Signature _- <br /> Y ! Month Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A (1/99) <br /> EPA 8700-22 <br />