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7 <br />Y <br />i <br />J <br />Z <br />L <br />;V <br />b <br />b � <br />V <br />V <br />0 <br />O <br />00 <br />W <br />W <br />1-- <br />Z <br />W <br />V <br />V) <br />ZI <br />O <br />LO <br />W <br />Q <br />Z <br />of <br />W <br />V <br />J <br />O <br />V <br />Z <br />0 <br />W <br />W <br />LU <br />0 <br />LU <br />Q <br />V <br />0 <br />.alifornia—Environmental Protection AgencySee Instructions on back of page Department of Toxic Substances Control <br />.roved OMB No. 2050-0039 (Expires 9-30-99) Sacramento, California <br />nt <br />or type. corm aesiynea w, v ­ ­, r.. _. , ­- <br />1. Generator's US EPA ID No. Manifest Document <br />No. Page 1 Information in the shaded areas <br />is not required by Federal law <br />UNIFORM HAZARDOUS <br />WASTE MANIFEST b q 3 % <br />O 8 <br />r I``°f <br />3. Generator's Name and Mailing Address <br />A. State Manifest Document Number <br />20670848 <br />Wic,r- STC p <br />B. State Generator's ID <br />Z152f�9 <br />Ti^l2- wF5r <br />4. Generator's Phone RA2 )3'7.:,- <br />3'7j.-5. <br />6. US EPA ID Number <br />C. State Tran porter's ID [Reserved.) <br />5, Transporter 1 Company Name <br />510-235-1393 D. Transporter's Phone <br />6COLOGY CCIiNTROL i P; USTIll <br />A1713 <br />R <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID [Reserved.] <br />F. Transporter's Phone <br />.q',j",'r �s g�^iy tY� 10. US EPA ID Number <br />gci .. ars� <br />G. State Facility's ID <br />H21 . facility]PIoneD <br />� � ., <br />rn,:e <br />L`j[j <br />OA 94801 �.s <br />11 . US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers 14. Unit <br />No. TypeWt/Vol I. Waste Number <br />State ii1?i!,JAC"iC= <br />C KADTV C'f`rNDA4"`i' `1All iV DIDIIKW-` <br />!1I tfi4�C_ I nj Vi♦ ( i6- 11 4%.'� <br />EPA/Otherf _)IQG <br />0dCM <br />E <br />State <br />N <br />E <br />b. <br />EPA/Other <br />R <br />A <br />State <br />T <br />O <br />c. <br />EPA/Other <br />R <br />State <br />JI <br />d. <br />EPA/Other <br />_-ti(ri i`IiiTe8- vTANK PIPIN ®. ..,_._.a <br />K. Handling Codes for Wastes Listed Above I <br />a, b. <br />R LUIVI ARL <br />VVeAWp*cVrRs EQUIPMENT WHILE HANWEiGDLING. SO V <br />APPROXIMATE. 'fid HOUR EMERGENCY CONTACT: /a1Ic <br />00T ERG 1, <br />00T ERG 1 <br />24 HOUR EMERGENCY TELEPHONE NUMBER: <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 />for transport by highway according to applicable international and n no government regulations. <br />marked, and labeled, and are in all respects in proper condition <br />to <br />ve <br />f I am a large quantity generator, I certify that I have a program in plac'otoareeduocedthe°vooll roe ands ova table to me whicwaste ty of waste rai in tOizes dhe present aand futurenthdeat bo human health I <br />have the method of treatment, s g p d the best waste management method that is <br />practicable and that I selected practicable <br />and the environment; OR, if I am a small quantity generator, I have made a good faith effor minimize <br />my wasgenet ion select <br />available to me and that I can afford. <br />Signature <br />CQonifj„ Day Year f <br />�f �''} r <br />Printed/Typed Name <br />,�jq �..✓ <br />17. Trans orter 1 Acknowled ement of Receipt of Ma rials - <br />Signature <br />Mont _ a .; � Year <br />m._. !,^-j"f % <br />T <br />R <br />A <br />R <br />Pnnte /Type Name <br />_ <br />'CIS (-., <br />(/ <br />G' <br />S <br />C� i� l S GL , <br />P <br />B <br />18. Transporter 2 Acknowled ement of Rece' t of Materials <br />Month Day Year <br />R <br />T <br />Printed/Typed Name Signature <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />20. Facility Owner or Operator Certification of rete% t of hazardous materials covered b this manifest except as noted in Item 19. Month Day Year <br />T <br />Printed/Typed Name Signature <br />Y <br />DO NUI Wl DC6VYY Irna s.ne`• <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />