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attire or v.mironua- onme ntat V.cn—hon r.gency <br />Form Approved OMB No. 2050-0039 (Expires V-30-99) See Instructions on back of p e 6. Department of Toxic Substances Control <br />Please print or type, Form designed for use on elite (12 -pitch) t1jilfter. <br />LU <br />Z <br />W <br />U <br />W <br />Z <br />O <br />W <br />Q <br />Z <br />0 <br />Q <br />Z <br />t— <br />Q <br />U <br />►I <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />4'�, <br />White 7SDF SENDS IHIS COPY TO DTSC WITHIN 30 DAYS <br />To: P.C)_ Sox 3000, Sacramento, CA 95812 <br />UNIFORM HAZARDOUS <br />1' erator's US EPA ID No. Manifest Document NMV <br />2 Page I <br />Information in the shaded area, <br />WASTE MANIFEST <br />is i�I Cil 211 ' t: 60 <br />p —7 <br />is not required by Federal law <br />i I I t <br />O � � 1 ! <br />of i <br />3. Generator's Name and Mailing Address i�'MFJ---flC N VA';5� # -- #((:_ }# 16V4t <br />A. State Manifest Document Number <br />_ <br />D III, {.aA 016-316 <br />B. State Generator's ID <br />4. Generator's Phoner'} <br />5. Transporter I Company Name 6. US EPA ID Number <br />C. State Transporter's ID [Reserved:] <br />R.? a ° °fit L, 0 0 0 i, �' °� p° <br />�� � $� <br />D. Transporter's <br />7 Transporter 2 Company Name 8 US EPA ID Number <br />E. State Transporter's ID [Reserved.] <br />I L <br />I I I <br />F. Transporter's Phone <br />-L <br />9 Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />J.A I L. 10 1 ol u I 3 ¢:# I ul al I <br />H. Facility's Phone <br />���� Y� : Ar CA :t,.361 IJy; I J�•,i I 19,'41 �g <br />11. US DUT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />14. Unit <br />No. <br />Type <br />Quantity <br />Wt/Vol <br />1. Waste Number <br />a — <br />Ri�'t6-6te dfi�iro 46dr:idtkti „#.1L°SET: #.1e6..#16xr <br />-- <br />State , <br /># <br />G <br />E <br />(I.ilit_l.) 010 <br />0 <br />..I. .#. <br />4:i <br />EPA/Other <br />N <br />b_ <br />State <br />E <br />EPA/Other <br />R <br />A <br />_ _ <br />T <br />.State <br />O <br />EPA/Other <br />R <br />d. <br />State <br />EPA/Other <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes for Wastes Listed Above <br />a: b. <br />01 <br />c. <br />d. <br />15. Special Handling Instructions and Additional Information <br />4::v ie.2V E.. 01 <br />is-.fat X:'_I'4'i.�d:"iol �_:s�t 4w�7a �'i'3 �_-<�?✓...��d c'r._isai;.}E' <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping narne and are classified, packed, <br />marked, and labeled, and are in all respects in proper condition for transport by highway according to <br />applicable international and national government regulations. <br />If I am a large quantity generator, I certify that I have o pro ram in place to reduce the volume and <br />that I have <br />toxicity of waste generated to the degree I have determined to be economicail) <br />practicable and selected the practicable method o treatment, storage, or disposal currently <br />available to me which minimizes the present and future threat to human health <br />and the environment OR, if 1 am a small quantity generator, I have made a good faith effort to minimize <br />available to me and that I can afford. <br />my waste generation and select the best waste management method that is <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />-R <br />Xt <br />s _ ��10 <br />R1 <br />7. Trans orter I Acknowl do ement o 1 of serials <br />l <br />A <br />N <br />Printed/Typed Name Signature <br />9 <br />Month Day Year <br />S <br />P <br />s .- <br />. <br />0 <br />R <br />18. Tra s orter 2 Ac Howie ement-o Rece � Materials <br />T <br />Printed/T ed Name <br />YP <br />Signature <br />— <br />-- <br />Month Doy Year <br />E <br />R <br />i l l l l <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />• <br />120 <br />Facility Owner or O erator Certification of receipt of hazardous materials covered by this manifest except <br />as noted in Item 19. <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />Y <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />4'�, <br />White 7SDF SENDS IHIS COPY TO DTSC WITHIN 30 DAYS <br />To: P.C)_ Sox 3000, Sacramento, CA 95812 <br />