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and FrontofPs' 7. toxicsuostancesControlDlvisb <br /> Please print or type. Form designed/or use on Wno, Itch typewriter). # Sacramento,Cailirnnir <br /> UNIFORM HAZARDOUS generator's US EPA fl)No. Manifest 2• Paget Information In the shaded areae <br /> WASTE MANIFEST C Q �' o m t No. i <br /> of is not requked 6y Federal law, <br /> 3. Generator's Name and Mailing Address R stats nat Oft <br /> �.. ��38umber <br /> was%�tr� r3v�� ,��� W,�•r��C .� �� �: 238$ <br /> 73] S.'. uAA 60?4l" S—J, mcgrrd I c)4" d:,stat.Generatoram' <br /> 4. Generator's Phone <br /> 5. Transporter I Company Name 8. U'S EPA ID Number C BtstsT)rtnypoitAr'a IIJ <br /> / S fs raneperterr FAoee <br /> 7. Transporter 2 Company Nems r, utt P ID Nunrhar „#;.- to 7rarnpawrr'a� ,,.a,..•. . <br /> F Tie Attune <br /> 9. Designated FeolFify Mame and Site Address 10. US EPA ID Number (i °lEatii]ao11Ny'e tD <br /> S SD tJ7`H !�!V' 11�~�/'� °� ! wFtusNty a Phone 4 <br /> MMC0a <br /> W¢ <br /> p 12. Containers 13. Total t4. 1.. <br /> (Y�� t t, US DOT DeeeHpYian(including Proper Shipping Name.Hazard Class,and ID'Number) quantity Unit IlYsals tip: <br /> \VQ No. 7YPe WI/Vol <br /> OoU a. I 8lgte <br /> CV)Z G <br /> N n EISA/OMer <br /> E b. 6/ <br /> V JN R 3 <br /> A <br /> (a T EPA/Other`Y ; <br /> N , O <br /> v R C. <br /> State-: . <br /> JUN 2 3 1992 EFA'Other <br /> LU a d Slat* i <br /> w ENVIRONMENTAL HEAn <br /> cl PERMIT/SERVICES EPA/Other . <br /> W <br /> J. Ad m{as�t�owariptions for MiItMleie t.la/t/t�td�Alta`m� Handling Coded,fur WV else Listed Above ti <br /> �4) <br /> Wcr <br /> E� ✓ art. r ,} <br /> O <br /> 1= 15. Special Handling instructions and Additional Information <br /> a 113. � — <br /> -7 <br /> U <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully endaecuratey described above by proper shipping name <br /> and are claaeined,packed.marked,and labeled,and are In all respects In proper condition for transport by highway according to applicable International and <br /> CL national government regulations. <br /> If I am a large quantity general or.i certify that I have a program In place to reduce the volume and toxiefty of weal generated to the degree 1 have determined <br /> 0 to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizae the <br /> } present and future threat to human health and the anvirommeal;OR,if I em a smelt quantity generator,1 have made a good faith effort to minimize my waste <br /> U generation and select the beat waste management method that is available to me and that I can afford. <br /> Z <br /> Printed/Typed Name Slgnatur Month flay •Year I <br /> W f <br /> W T 17. enspo er 1 Acknowied ement of Receipt of Materials <br /> R � <br /> A Printed/Typed Name 8lgnalu a Month Day Year <br /> N <br /> U.O S A Id <br /> P <br /> wv O 18. Traniporter 2 Acknowledgement of R celi <br /> of Materials- <br /> Printed/Typed <br /> Name S eture Month Day Year <br /> E <br /> Z <br /> 19. Discrepancy Indicalton Space <br /> F <br /> A <br /> C <br /> 1 <br /> L <br /> 1 20, Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted In Item 19, <br /> T <br /> y Printed/Typed Name signature Manch Day Year <br /> DHS8700 A <br /> EPA 8700-22Do Not Write Below This line <br /> EPA . <br /> (Rev.6-e9)Previous edition*are obsolete. Blue: GENERATOR SENDS THIS �006 6owwrrw 30 DAYS <br /> ^ry- To: P.O. Box 400, Saaamelitio,CA 95812-M <br />