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US <br />W <br />Z <br />V <br />w <br />N <br />Z <br />0 <br />w <br />ce <br />Q <br />O <br />Q <br />Z <br />w <br />e- <br />J <br />Q <br />t.J <br />to <br />O <br />V <br />Z <br />w <br />Uj <br />W <br />g <br />w <br />0 <br />w <br />V7 <br />Q <br />U <br />2 r. <br />,&n ronmental Protection,Agenry'. <br />LLB;No. 2050-00'39 (Expires 9 30 99) S@@ Instructions OA back ofiff :S. Department of Toxic Substances Control <br />r"' Sacramento, California ! <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />Yellow: GENERATOR RETAINS <br />1. nerator's US EPA ID No. Manifest Document No. 101 <br />- 5 <br />2. Page 1 <br />Information in the shaded areas <br />is not required by Federal law. <br />UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />C` 1? �J O 0 S p ' �' <br />of I <br />3. Generator's No and Mailing Address <br />A Stats Manifest Document Number <br />20,670848 <br />GVIC-(» $70P <br />e:' stat® Gen®raror fa <br />-7-2-7i W s fi t , 7vt14 ry q C 52 v 9' <br />A. Generator's Phone (q10 ) 37 3 « % NT <br />5. Transporter 1. Company Nome 6. US EPA ID Number <br />C. Stals Tronsporter's ID ( serveJ <br />Transpartsr`s <br />fiCi?i,t;k0V C,0114TROL, #NOUs�"k" Wd$ {' ' ,t <br />D: Phone 010-.235-1393 <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E.State Tronsporter's ID [Reserved.] <br />tl <br />Fl Transportees Phone <br />10. US EPA ID Number <br />G. Stqie. Facility's 1D <br />265 PARR LVE) <br />9 21, <br />+ <br />H, Facility's Phone � Q i ' 3913 <br />€ tClfi D ,CA �� <br />11. US DOT Description (including Proper Shipping Nome, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />Quantity, <br />14. Unit <br />Wt/Vol <br />1. Waste Number <br />Na <br />Type <br />NON R(;RA a VVASTL 50LU <br />State 51 '. <br />1,AtAVTC r,jkA ,rY (-N,t,�rA,r-3- TANK <br />t, c.AVIV t <br />EPA/Other <br />, <br />E <br />b <br />State <br />N <br />EPA/Other <br />E <br />R <br />A <br />State <br />T <br />c <br />EPA/Other <br />O <br />R <br />State <br />d. <br />EPA/Other <br />K. Handling Codes for Wastes Listed Above <br />.w <br />alkt <br />I OR <br />AP I PROXIMATE 24 Houp, E*RGENCY CONTACT-, <br />24 HOUR EMERGENCY , TELEP WNE NUMBER: Do"! VRG 1'n <br />16. GENERATOR'S CERTIFICATION: 1 hereby declare. that the c4ntenfs of this consignment are fully and accurately described above by proper shipping name and are clossifre8, packed, <br />for transport by itaccording to applicable international and n 'nal government regulations <br />marked; and labeled, and ore in all respects in proper condition <br />If I am a large quantiyy generator, I certify that I have a pr ram in place to reduce the volume and toxicity of waste general toAhe degree l have determined to be economically <br />and that Lhave selected the practicable methodof treatment, storage, or disposal cur y available to whit ini izes the present and future threat to human health <br />d select the best warts management method that is <br />practicable <br />and the environmenh, OR, if 16m o small quantity generator; I have made o good faith' is minima® my wast gene, ton <br />available to me and that I can afford. <br />Printed/Typed Name Signature fy)on ay {�ear� <br />T <br />17. Transporter 1 Acknowledgement of Recei Dt of Materials « <br />ant „pay,., earj <br />Name Signature j / <br />A <br />5 <br />�l s*Jj „, <br />,P_riinte#Type <br />P <br />�1 Y��L .. <br />Trans iter 2 Acknowled ement of Race' t~of Materials Month Day Year <br />R18. <br />T <br />Printed/Typed Name Signature <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />20. FacilityOwner.or OI ion of receipt of hazardous materials covered by this manifest -except as noted in Item 19. Month Day Year <br />j <br />Printed/Typed Name Signature <br />Y <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />Yellow: GENERATOR RETAINS <br />