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r State of California—Env;ronmenlal Protection Agency <br />Form approved OMB No. 2050-0039 (Expires 9-30-991 .' . S@@ Instructions OO back Of O @ 6. <br />9 Department of Toxic Substances Contra <br />Please print or type. Form designed for use on elite (12 -pitch writer. Sacramento. California <br />- DTSC- 8022A { rf99): - -- <br />EPA 8700-22 <br />UNIFbRM., HAZARDOUS <br />nerators US EPA ID No. Manifest Document <br />2- Page 1 <br />Information in the shaded areas <br />WASTE MANIFEST <br />is not required by Federal law. <br />,y n n ry ftLq17 7 <br />e <br />of <br />3. Generator's Nairte and Mailing Address <br />A State Manifest Document Number ' ' <br />PSC.!"'r. �asr+t�^ s'eHC '!ri^4 er.•tt tT-•r•,a/ F^<r"R1/'1R' q 9! e/'� n IRe 6}MM I�'6.e a Oe'!r, e+e'P'e:^0-9 <br />I,r<f..bMK✓br 40uJdlWOdV Gia:lt9}.l(..b-e.lR'-.Mri}y.dV•Yewtlii'8V"•.li Fs•sse6`s... lJf 64.. <br />_-7:7 <br />) <br />1P'.6i. isox ,5 :JtNHJ6J r! QLt/ys 4'4taf t:.0CK. t VTV , A az6— <br />cis!® <br />T <br />B State Generators 10 <br />A. Generators Phone ( 71h4 1!t itl.9fifKF #Ci=Fa�•R 1�iittt tv_ <br />• <br />M <br />S. Transporter 1 Company Name 6. US EPA ID Number <br />C. State Transporter's ID[Reserved] <br />r <br />D. TraPans rters Phone <br />• ' , <br />j <br />TMI+• h/ti 4/ r�As1Y-Pf YO• <e•'cs 1N+Tl+.var`e^ h {'O A{ IV h .d OA <br />e 0 G V s? 0 >E f J <br />e.a.vs.vv } �.vev a mars. alae iv.s a seas a 14 �'p 910121013 <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporters ID fRese,rved.] <br />c <br />F. Transporters Phone <br />9. Designated Facility Name al Site Address 10, US EPA ID Number <br />G. State Facility's ID <br />S <br />ECOLOGY CONT'WX_ fN1)AJ STR±E_', <br />4 37:!A WBmrnP tl .,` <br />H. Facility's Phone <br />i <br />i <br />- 4 A d h / r.. h A <br />t t3tT .dd"t:s. +,i /e 312141814 <br />i 4 fi r4� q n i V Rae is <br />C <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />14. Unit <br />No. <br />Type <br />Quantity <br />Wt/Vol <br />I. Waste Number <br />11,,i> t �: T-=':Zf<A ;17� T A:T,IK <br />State <br />• � - <br />r2, , <br />EPA/Other <br />G <br />I" on --H (_. RA aZ,-a1 f~ l .� :}`ras– f <br />t <br />--r <br />T) <br />f <br />N <br />b. <br />State <br />E <br />EPA/Other <br />t R <br />f A <br />> T <br />C. <br />State <br />i O <br />EPA/Other <br />R <br />i <br />d. <br />State <br />i <br />EPA/Other <br />J. Additional Descriptions for Materials Listed Above <br />t7a i wit. 33 -FTS =Fda)titif i }-J ripA( t- I A.rtk / tiK t- Cr <br />K. Handling Codes for Wastes Listed <br />a• <br />Aboye <br />b- <br />j <br />F6aJ£.trlr�iy r}aa.,I/J4.e6..}J. - <br />= <br />L <br />c <br />d <br />15. Special Handling Instructions and Additional Information <br />LNFAR APPROPRIATE P.P.I~. WHII_I* HANDLING SITE: f}WC..9F. Rt_IX3 100 i <br />t <br />�—", <br />�6' f l ! t/"<F"''A r.,"�<1 '1°f" e"'r`0i 6t'aK t�l'� jl "r! flit Y'Y^r "t fYr"r•"'%'Rt•^�".P-��L+, "'-Y"<l:^.(. e`2^!, ., "' <br />644 ;fi-t�lU EMERGIrE to 1 a C�.t.:t—t-t<O aa: f' rJUVI JCC, s eJvkt S 1./T: f R [YtA. Cs s lR,ti d t�tUSl I t4s'tef <br />I~CI JOB # 38693 TANK# 900'76 I. ATHROP CA, 95330 <br />i <br />16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, <br />marked, and labeled, and are in all respects in condition for transport by highway according to international <br />l <br />proper applicable and national government regulations. <br />If I am a large quantify generator, l certify that I have a program in placereduce the volume and toxicity of waste generated to the degree t have determined to be economical) <br />practicable and that 1 have selected the practicable method o treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health <br />and rho'Sn"ronmenh 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 />available to me and that 1 can afford. <br />Printed/Typed Name SignatureMonth Day Year <br />Jr9 so' �'�' 01+� � all <br />17. T= 1 Acknowledemen, of Receipt of Materials <br />i T <br />i R <br />Printed Name <br />Signatur <br />Month Day Year " <br />P <br />��tt A f/ <br />LAe A f � l tJ (L. r} tY <br />r. 4�.w .. � .LIP <br />! �_ <br />8 <br />18. Trans 2 Acknowledgement of Receipt of Materials <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year ' <br />It <br />; <br />i• <br />reportcy Space <br />19< Diu lexlieatioet <br />L <br />f <br />20. Facility Owner or Certification of receipt of hazardous materials covered this manifest exceptas noted in Item 19. <br />TPrinted/Typed <br />Name t - <br />Signature <br />Month Day Y <br />Y <br />'I'dCr <br />- <br />�I`h!/��i <br />- DTSC- 8022A { rf99): - -- <br />EPA 8700-22 <br />