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State of California—Environmental Protection Agency <br />^Form Apprtved OM& Na: 2050-0039 (Expires 9.30-991 See Instructions on backge 6. <br />Pleose`print or type. Form designed for use on elite (12 -pitch/ writer. <br />UNIFORM HAZARDOUS LIA <br />Generator's US EPA ID.No. Manifest Document No. <br />WASTE MANIFEST,aC 7; ` <br />3. Generator's Name and Mailing Address <br />Ciw k7 r.3 r91c"®" +� P41; 14 <br />In 4. Generator's Phone (,;C1r, <br />11 <br />as <br />N 5. Transporter 1 Company Name b. US EPA ID Number xr <br />in <br />CR <br />O <br />O <br />J <br />J <br />Q <br />Iffm <br />7. Transporter 2 Company Name <br />8. US EPA ID Number <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />. -- E-WIRONM7AL SERVICES <br />1515 s % Z s!Vr-R ROAD, WT SACRAMENTO, `.A 9.5691 <br />� "� 11. US DOT Description lincluding Proper Shipping Name, Hazard Class, and ID Number) <br />V <br />O 15. Special Handling Instructions and Additional Information <br />Z a't;�,NIMMRS BE `wr� L't.i '0,3F A r S',si�i�A 7, 7AIN s <br />LU AND USE 11TiC'S ? ;fix PROVE'? PPE. <br />EMARGENCY : (916) 1-5747 <br />12. Containers <br />No T Typ <br />Department of Toxic Substances Control <br />Sacramento, California <br />2. Page 1 Information in the shaded areas <br />s not required by Federal law. <br />of j <br />13. Total 14. Unit <br />Quantity I Wt/vol <br />= I I 1 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 />Vmarked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulations.. <br />-+ If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br />a practicable and that 1 have selected the practicable method of treatment, 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, 1 have made a good faith effort to minimize my waste generation and select the best waste management method that is <br />Ix available to me and that I can afford. <br />O <br />} Printed/Typed Names --A Signature' Month Day, Ye( <br />U Ai <br />Z <br />s <br />w <br />0 <br />It <br />b. <br />o <br />N <br />� <br />LU <br />A <br />E <br />v <br />R <br />f <br />4 <br />A <br />w <br />o <br />T <br />C. <br />00 <br />O <br />LL. <br />0 <br />R <br />w <br />0 <br />d. <br />r <br />Signature <br />Z <br />Month Day <br />ur <br />w <br />N <br />E <br />R <br />r, <br />u -t <br />U19. <br />ZOa- <br />WaJd <br />F <br />A <br />n, <br />lovZ <br />C <br />f e <br />O 15. Special Handling Instructions and Additional Information <br />Z a't;�,NIMMRS BE `wr� L't.i '0,3F A r S',si�i�A 7, 7AIN s <br />LU AND USE 11TiC'S ? ;fix PROVE'? PPE. <br />EMARGENCY : (916) 1-5747 <br />12. Containers <br />No T Typ <br />Department of Toxic Substances Control <br />Sacramento, California <br />2. Page 1 Information in the shaded areas <br />s not required by Federal law. <br />of j <br />13. Total 14. Unit <br />Quantity I Wt/vol <br />= I I 1 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 />Vmarked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulations.. <br />-+ If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br />a practicable and that 1 have selected the practicable method of treatment, 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, 1 have made a good faith effort to minimize my waste generation and select the best waste management method that is <br />Ix available to me and that I can afford. <br />O <br />} Printed/Typed Names --A Signature' Month Day, Ye( <br />U Ai <br />Z <br />s <br />w <br />0 <br />TR <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />LU <br />A <br />Pri ed/TyppedgName t -j� <br />Signature <br />t i�4 <br />f <br />Month Day <br />j. <br />Yea., <br />r <br />w <br />P <br />! d Ii4 3 �1. \l <br />LL. <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />0 <br />R <br />Printed/Typed Name <br />Signature <br />Month Day <br />Year <br />w <br />N <br />E <br />R <br />U19. <br />Discrepancy Indication Space <br />Z <br />— <br />F <br />A <br />C <br />L <br />R r <br />1 <br />20. Facility Owner or O erator Ce' FicoAordof rete f.a <br />clots naateoia cd�dYe b Ais manifest exce t.as noted in Item 19. <br />T <br />Printed/Typed'Name a <br />Signature. " <br />1 <br />Month Day <br />Year_ <br />1,DO <br />NOT WRITE BELOW THIS LINE. <br />r <br />DISC 8022A (4/97) White: TSDF RETAINS <br />EPA 8700-22 <br />