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State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back of a 6. Department of Toxic Substances Control <br /> Please print or type. Form designed for use on elite 112-pitch) iter. Sacramento,California <br /> 1. Generator's US EPA ID No. Manifest Document No. 7-a�l <br /> e 1 Information in the shaded areas <br /> FORM HAZARDOUS .= r i �10:ryd ej �j j '% is not required by Federal law. <br /> WASTE MANIFEST <br /> er Lor' me d i ipg Address J c t A. .. "` Z= A. State Manifest Document Number <br /> 43t �� , � ffi <br /> �,AATN: 'INAI�J�.0 : A 3hi : <br /> O LATHHfOP "�; `i� + i�} B.,Statedeiierator's'ID <br /> vt �'7. t ... m, 1F,. .. <br /> LO A. Generator's Phone( c- 98, i <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] <br /> LO <br /> ao SA;ETY-.K[_EEP1 ;;�aY�a".'E$`�S .NCI 1..XR �ti4`;;4: <br /> o D. Transporter's Phone 800, 669-5740 <br /> a0 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID Reserved.] <br /> F. Transporter's Phone <br /> [ r� <br /> ncli r 10. US EPA ID Number G. State F cili <br /> ss <br /> 96 f 39X119 <br /> SAL S JA r' C "?- u3;3 6$,.-3L.' °$" }" {� .,3'5d &) H. Facility's Phone <br /> a <br /> }J12. Containers 13. Total 14. Unit <br /> V 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) <br /> No. Type Quantity Wt/vol I.was - umber <br /> QZ °' 17 <br /> USED CLEANING COMPOUNDS, Nti 0. 1, B. I. ,M G $tote 134 <br /> L I OU I D (NOT 1W1 T aR USEP r R Y-GU A TED <br /> 3 G AQUEOUS PARTS WASHER 'SCH..(.��'1"t' N %1 r u���t�r``,? r` ,f/ ` EPA/Other <br /> / <br /> E <br /> w N b. state <br /> co E <br /> EPA/Other <br /> 4 Rv A <br /> C. sf <br /> O T State <br /> 00 0 <br /> R FEB 07 0 EPA/Other <br /> � 4�ss <br /> 205 <br /> W d. State <br /> F- <br /> Z , <br /> LU B Y..___._.___�___ <br /> V EPA/Other <br /> LU <br /> N J.Additional Descriptioins for'Moteriols Listed Above K: Handling Codes for Was)es Listed Above <br /> Z <br /> Oa ` a'. b. <br /> CL ri i <br /> 14LO <br /> s C. d.. <br /> Z 5 � u aeeg <br /> li`1� �l�g�nsir w•� ��f�r�ationi ,°M,y�;d� i� e"I .. <br /> F- <br /> Q <br /> Z <br /> LU A C 4 :' 7 <br /> r <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 /> 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 quantify 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 /> CL practicable and that I 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 /> V) and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> M: available to me and that I can afford. <br /> O <br /> } Printed/Typed Name f Signature Mont oy Year .Y <br /> Al_. d. <br /> LU <br /> -'R W, <br /> 17. Transporter 1 cknowled ement of Rec' "f Materials <br /> A Printed/Type ome �Rec <br /> - �ig�not—�� rjnth ? Day 1(ea <br /> O0 18. Transporter 2 Acknowled�ment of ei t of Materials <br /> T Printed/Typed Name Signature Month Day Year <br /> N R_ <br /> V19. Discrepancy Indication Space <br /> Z F . <br /> A <br /> C <br /> L <br /> tr' <br /> l 20. Fa di ner or Operator Certification of reklipt of hazardous materials coverb his manifest ce t as not in Item 19. <br /> T Printe T N m r r ✓j' Signat re �- ® j, `f ) nth �nDay ti �Y�ear <br /> DD NOT WRITE BELOW THIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENBRA�OR WITHIN 30 DAYS. <br /> DTSC 8022A(1/99) (Generators who submit hazardous waste for transport out-of-state, „* <br /> EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.) ' <br />