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E <br />State of Colifornio—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9.30.991 <br />Pleose print or type. Form designed for use on elite (12 -pitch) typewriter. <br />C <br />r <br />l <br />Mt <br />C, <br />C <br />C <br />0 <br />U <br />U <br />L1 <br />C <br />0 <br />0 <br />a <br />C <br />Ii <br />Ll <br />See Instructions on back of page 6. Deportment of Toxic Substances Control < <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (4/97( `^Whoa TSD° SENDS THIS COPY TG Ui: <br />EPA 870C-22 Rrx ..;rti CAtiS. <br />D 3000. Socromento C:. <br />....j .. ...... .:;;� ''_. .. �. :o _� . .b i'<. <br />UNIFORM HAZARDOUS <br />1. Generator's US EPA ID No. Manifest Document No. <br />2. Page 1 <br />Informotion in the shaded areas <br />WASTE MANIFEST <br />O ©oo 61 to ; Z j 3 <br />of <br />is not required by Federal low, <br />3 Generators Nome wd Mailing Address �t r� <br />CSC 4 iI{;iLi.GZ e+NiL %.Q, yrrAl T 3 j&:77 7�J0YVp.S0-,/ <br />i't6i�Mandost'Doevman7lstumberf <br />-2.eAC1fS CfOt�i Ca-IyaN %�l.3iYOC S�n/^R4MdN CA 4qSP3 <br />c z a ° 6 <br />i <br />4 Generator's Phone (SIO )'Z'7.7_230 <br />i <br />ae <br />t <br />5. Transporter i Company Nome 6. US EPA iD Numberjofe.gyssppyr�.„ <br />F„ <br />f� <br />r}� Li1!}�j '_ Cif NiiZ�eC'A% a. -+L, �rNjl� <br />rispd7te�s•�!fsgss$.,, /'�.� � �s <br />Dffo ;, (,d(J'V%J' <br />) <br />�j !� 7 C �g <br />p® I -1 a 4 <br />7 ✓ <br />7. irons rter 2 Com on Nome <br />Po pony 8. US EPA ID Number <br />-�q� <br />ice^ <br />E.StateT—YTraagprxfeCatD <br />Y <br />i <br />fTtgrtsposter s khoae <br />9, Designated Focility Nome and Site Address 10. US EPA ID Number <br />f <br />G. StaFe("0nlify's�dD <br />r14.'hiG �PPV'sR.OrJM.C+sfZ+lil- l�G:'�rl@'L©z11GS GG� <br />'� � � L� '�„ <br />ZO? S3ciU s2 G CL CI <br />ff Fdc hty'i Pfroiie <br />tsT <br />4i� G� +� 30 3 = o Z15174�3 <br />2 <br />j <br />1 111 11 US DOT Description (including Proper Shipping Nome, Hazard Class, and ID Number( <br />12. Contoiners <br />13. Tocol <br />14. Unit <br />No. <br />Type <br />Quantity <br />wt/vol <br />1.; Waste Number <br />a WAaSTF, t=t_A[h v:4kji filAS f N.d.S3 <br />state. <br />E <br />UN f qq 3 66-4FSe 11)� <br />EPA <br />d 1 <br />i <br />�j— <br />�4 j <br />N <br />b. <br />E <br />� k <br />EPA/Ots eF d "q <br />R <br />A <br />T <br />c. <br />I <br />Shsle „w <br />O <br />R <br />1 <br />?PA/Other ` <br />d <br />Smote <br />-ElsA/Other :< <br />I <br />� <br />J.:'Additfottof:Descnptions'(or Motedats':ListedAbove""" _ <br />1C"t and Ing Codli Foix+h7aztes.Lsled'Above <br />o <br />_ <br />15 special Handling Instructions and Additional Information —eP <br />�Si. A�P''c(3i2.'Ai�. CLaY*-��t.1ia��3-►�GS�.rc;Z-or' <br />i ib50o =C vaseA-vt <br />2 �1 h 2 Em V Cont:.. U.c`�,•df, C.a <br />'1-S' <br />Cfileroc-7aec ©�- �Z�-930 © r� tic NozI r 4,? kpz4F Z33a <br />16 GENERATOR'S CERTIFICATION: I hereby dectere that the contents of this consignment are Fully and accurate[ yy described above by proper shipping name and ore classified, packed, <br />marked, and labeled, in in for <br />and are oil respects proper condition transport by highway according to opplicable international and notional government regulations. <br />If I om a large quenri generator, I certify that I have a progtom in place to reduce the volume and toxicity of waste generated to the degree 1 have determined to be economically <br />practicable and that I have the disposal <br />iI <br />selected racncable method of treatment, storage, or currently wailoble to me which mi:iimizes the present and Future threat to human health <br />and the environment; OR, if I am o smolt quantity generator, 1 hove made o good faith effort to minimae my waste generation and select the best woste monogement method that is <br />avoiloble to me and that I can afford. <br />. Printed/Typed Nome <br />CI'�l��vT <br />Signa re <br />Month Doy Year <br />JERR.OM'( CA�RCf.L co�� <br />17 Transporter 1 Acknowled ement of Rece t aF Materials <br />A <br />Printed/Typed Name <br />signotur <br />Month Day Year <br />N <br />S <br />P <br />�r0, <br />g <br />18. Trot ns rte Acknowledgement of Receipt of Materials <br />TPrinted/Typed <br />Name <br />Signature <br />Month Day Year <br />E <br />R <br />F <br />19. Discrepancy Indication Space _ <br />L <br />Z z, l% <br />!`cz' l- <br />1 <br />IT <br />70 ;I;p e2tc.-t' SrV v'h=- man fe-' ' cE2-'_ •aGd r.'1D ftaa <br />Printed/TPed NSignature <br />Notn pay Year <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (4/97( `^Whoa TSD° SENDS THIS COPY TG Ui: <br />EPA 870C-22 Rrx ..;rti CAtiS. <br />D 3000. Socromento C:. <br />....j .. ...... .:;;� ''_. .. �. :o _� . .b i'<. <br />