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• mow., sTors 12� <br /> Slate of Cibforrus—1feann and WelfareAgency <br /> ...�..................:...... <br /> / <br /> Form Approved OMS No.2030--003 t 9(Expires 9.30.88) - �� � � ��/�'ti y� � 6�. `� Toxic subataneas Comrol Division <br /> .Please print or type. Form designed for use on elite(12-pitch typewriter). Sacramento,California <br /> UNIFORM HAZARDOUS ocume <br /> 1. Generator's US EPA►D No. O M.nnif.ns, 2, Page I Information in the shaded areae <br /> WASTE MANIFEST ) of is not required by Federal law. J <br /> 3. Generaloi•Name and Mailing A40ress A. State aManifest Document Number 6 0'7 344 <br /> ` <br /> �. rsoX STys <br /> �t , 4/1 3/ 8. Stat.G.n.rator a D <br /> 4. onerator's Phone(YDS <br /> 5. Transporter 1 Company Name 6. US EPA 10 Number C. Slate Transporter's ID 941 <br /> n <br /> T)i(/[(/ i % O. Transporter's Phone <br /> 7. Transporter 2 Company Name 8. US EPA IO Number E. State Transporter's ID I <br /> F. Transporter's Phone <br /> 9. Designated Facility Name red Site Address 10. US EPA 10 Number G. State Facility's ID <br /> --4 S1IA- -4-Y C 5 t,..r1CC S <br /> /(/T✓ h'OA <br /> H. Facility's Phone <br /> 1,><s.N,ycl.� !,✓ 93 7- I <br /> 12. Containers 13. Total 14. 1. <br /> 11. US OOT Description(Including Proper Shipping Name,Hazard Class,and 10 Humber) Ouentity Unit Wast.No. <br /> No. Type WtIVo <br /> a- IN If 2 14 k'4G l(/g57r/ SucC,: , ,cJ?s. D.itrtl�= state <br /> G / <br /> N /�`1 Q/ ) EPA/Other <br /> E b. I / <br /> Slats, <br /> R <br /> A <br /> T EPA/Other <br /> 0 <br /> R C. <br /> Stat. <br /> EPA/Othor <br /> d. <br /> Stats <br /> e EPA/Other <br /> J Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> tr�!�c'nC(l.11 lo�r.;�+s�.✓-lj�-�:� l.i �c_ `''S: S/ u.';asi .. b. <br /> 15. Special Handling Instructions and Additional Information <br /> tlll%aC v/elli `__ i'/(,'_ ''i%r tf a I^'. •,- �.', i(_".••>•1'e ,- i•L. •-!�i.6 ,/ems;_-� N•.;✓<•:J'n.l•/ <br /> // 1i "' _ �• � <br /> ( 1 <br /> 16. <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping <br /> name and are classified• packed, marked.•and labeled, and are in all respects in proper condition for transport by highway according to applicable <br /> 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 1 have <br /> determined to be economically practicable and that 1 have selected the practicable method of treatment• storage, or disposal currently available to <br /> me which minimizes the present and future threat to human health and the environment: OR, if I am a small quantity generator. I have made a good <br /> faith effort to minimize my waste generation and select the best waste management method that is available to me and that 1 can afford. <br /> Printed/Typed Name Signature Month Day Year <br /> T 17. Transporter I Acknowledgement of Receipt of Materials <br /> R <br /> A Printed/Typed/Name Signature Month Day Year <br /> 0 8. Transporter 2 Acknowledgement of Receipt of Materials •� <br /> R Prmledt <br /> T Typed Name Signature Monfn Day Year <br /> E <br /> t9 O.screoancy tnd.cat.on Space <br /> 1 F <br /> ' A <br /> 1 C <br /> I <br /> I L I <br /> 1 20 Facaoy 0-..,,N Operal Or Cert.l.cal.on rel receipt of hazardous materials covered by this manifest..Cept .x noted m Item 19 <br /> T <br /> Y Printed.Typed Name Signature Month Oay Year <br /> P 8700 INSTRUCTIONS ON THE BACK A(lief) <br /> EPAEA <br /> 6700-22 � _ .. .. .. ..... <br /> (Rev 9.86) Previous eddions are obsolete. J. .... ."'• ',_�._�:a;.'.,• �.. .. <br /> IN CASE OF AN EMERGENCY OR SPILL. CALL THE NATIONAL RESPONSE CENTER 1-800.424-8802: WITHIN CALIFORNIA CALL 1.800-852.7550 <br />