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~ Font. Approved OMS No, 2160--0039 (expire® 9. <br />> . Zrint a lupe. (R'cvm bht wag for 000 on <br />lljUNIFORM H RDOUS <br />n . . WASTE MANIFEST <br />I. Gsneratorli U8 EPA ID <br />%il Af a O t 0,40a ai.1 <br />�U /3aJC rj-7Y3 <br />4. Gon«atoee Phone (y/S) fo 51 —O :6®0 <br />f TraQsportarA Co rpotM plain• a. <br />7 <br />R, ignatad F elNty t(am® <br />iv u to. <br />Nbrld.ii.aat 4+ rmmtn .,r.cua... <br />Toxic,Substanc•s Contr <br />/ Sacramento. California <br />I ®IManuel;2• P+9e T Infor ntation to the ahoded areas <br />I if I of is not req*" by federal Iaw: <br />C. -state Transpot <br />F. Transport•r's Phone <br />.a BtatsFaoNMy'i ID <br />ri"tt O/tD �iG r <br />H. Fay's t'hons <br />III : US DOT Description (Including Proper Shipping Name. Hazard Class. sQ;3 12. Containers IS. Total 14.; L Quantity Untt Waste No. <br />` No. I TypeWt/vo <br />a. 41'f4 Z AX tW W 3 / G O ' ,ate <br />£-_ J •� A - ($tail <br />R 1. <br />e A t r EPA/Ott- <br />state, <br />therState. <br />% <br />c *� •EPA__/.QYtir . <br />g.' <br />t �- _�• <br />:: � EPA/Outer . JJ <br />i ° � "GOdlls.tot-Waatu'Uat®d Above <br />t b. <br />- <br />1 .�e •!"s' f+GLN <br />c�r }''moi k <br />martian Handling brstructions and Additional Inforntatbs <br />�, ria �: w Loves - �'.i-.tes fJ,r,,,,r.�,at..,,� fr- �'..l�.f•.�` • ,.� `"'`' <br />' a! .:RATOR'S CERTIFICATION: 1 hereby declare, that the cont of consignment are full and accurately described above by proper shipping <br />�* Y Y elY PP ng <br />napipand ars classified. packed, marked; and labeled, and arfteall respects in proper condition for transport by highway according to applicable <br />intel-Wicral.and national government regulations. <br />If I am a large quantity generator. I certify that 1 have a program r uce-the volume and toxicity of waste generated to the degree 1 have <br />ejermlped toP!economically. %acticable and that I have selects c l (a method of treatment, storage, or disposal currently available to <br />- �¢ _� I[rtrr+ �ntS etc=i actf:i icra�fiieat►rtarl: ho+tti a , on Atant: tOR: If L ami small pusntity.gene,rator, l,Pypvp, made a good <br />1I faith `rtort to minimize my waste generation and select the at a.. ge,nem thud that is available to no and that I car attord. <br />/Typed • . Month Day Year <br />p - t <br />R 1.. Trs er 1 k*40w1odgomolit of Receipt of Materials <br />A P <br />t; r /Typed Name a Month Da <br />P <br />p 18. Transporter 2 Ackoowl gement of Receipt of Ofteddle <br />R <br />T P-inted/Typed Noma Signature Month Da <br />E I . <br />19. Discrepancy indicatkn Space <br />t F <br />i A <br />I <br />i 120. Facility Owner or Operator Certhication of rec_,4pt o' hazardous materials covered by this monif•at except as noted In hem 19. <br />YPr d/Ty ed Name ignatwe / Month Day Year <br />-- _986 !� M;(a rcPS �c l 4 <br />OHS 8022 A (1/ 87) Yellow: TSDF SENDS WS COPY TO G64ERATOR WITHIN 30 DAYS INSTRUCTIONS ON THE BACK <br />EPA 8700--22 <br />%Rev. 9-88) Previous editions are otsolete. <br />1N CASE OF AN EMERGENCY OR SPILL. CALL THE NATIONAL RESPONSE CENVOI 1-800-424.8802; WITHIN CALIFORNIA CALL 1-800-862-7650 <br />