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All <br />State of California—Environmental Protection Agency <br />Form Approved OMB No. 2050-0039 (Expires 9-30-99) See Instructions on back a b. <br />Please print or type. Form designed for use on elite (12 -pitch) ;,ewriter. <br />" <br />D artment of Toxic S'Gu'�bstances Control <br />agRp to;Adlifornia <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />UNIFORM HAZARDOUS 1 . Generator's US EPA ID No. Manifest Document No. 2. Page ( or ti a re <br />WASTE MANIFEST snot required by Fede aw. <br />of <br />3. Generator's Name and Mailing Address <br />. State Generator's ID <br />A. Generator's Phone ! '+.-t�- j a r ; r° _ <br />5. Transporter 1 Compa{nyp Name 6. US EPA ID Number <br />C. State Transporter's ID R ] <br />i4l ppl ".is Ab,i 3pn 6. A....'Y f�a� TY r�.� > �q _ i•Y ... ,�i • -.n' <br />4M x7 4.. i h A a✓ M J `b ! rh. ... 0 f"+.-1 ? t.. }': L. L.s e«a i 1..+ ,.3 �.� •2 S. e <br />p�, /ry}°•i 5.�..�a L` <br />T t� pl;` � 7� >i . }. f.'.^YC)^+, l <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />E. State Transporter's ID (Reserved.] <br />F. Transporter's Phone <br />i 1 9�c1 F JitytRl nem �i /�iddr ss]•� 10. US EPA ID Number <br />G. State 's ID �, r <br />�F-0aciIi <br />t� 1� <br />:r"0C,z 1J LA "�'. 1f F0A0 <br />1 1 <br />H. Facility's Phone <br />p^. q� 'tM1d {) l <br />YiI hr Ei'<U AN i' ,0A t4s�a,' +✓ A 41-10 10 1 ® 0 3 1 <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12. Containers <br />13. Total <br />Quantity <br />14. Unit <br />Wt/Vol <br />I. Waste Number <br />No. <br />Type <br />_�— __. <br />a. NON-RC..rlA `tre'�►a;�.i'�L%.�aA'1tiS gVA,13TE L.iG. l itri <br />State ._._. <br />.t.,. <br />EPA/Other <br />G <br />E <br />ri <br />N <br />b. <br />State <br />E <br />EPA/Other <br />R <br />T <br />C. <br />IVOLl <br />State <br />R <br />EPA/Other <br />d. <br />(T <br />State <br />\ <br />EPA/Other <br />ddition scriptionsttFF�or�r Materials Listed Above <br />K. Handling Codes for Wastes <br />Listed Above <br />OILY ATZR <br />4v <br />a. j}:t <br />b. <br />C. <br />d. <br />15. Special Handling Instructions and Additional Information <br />L 0 V `1 <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 />marked, 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 quantity generator, 1 certify that I have a program in place to reduce the vclume and toxicity of waste generated to the degree I have determined to be economically <br />and that 1 have selected the method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health <br />practicable practicable <br />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 />available to me and that I can afford. e r 1 <br />r <br />Pnnted/Typed Name <br />Signature Month Day Year <br />,', F, �. '•s.,.., a`t L^a �' �.+,>{L.1iy'...-+ <br />"-' 44...-' f-- f, L............m ' ' j ''J' f .t <br />-,d V � <br />T <br />17. Trans orter 1 Acknowledgement of Recei of Materials <br />R <br />APrinted/Typed <br />Name r <br />Signature + /"P^ <br />Month Day Year <br />IL)0 <br />P <br />1 S. Transporter 2 Acknowledgement of Receipt of Materials <br />TPrinted/Typed <br />Name <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />I <br />L <br />1 <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19, <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />Y <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (1/99) <br />EPA 8700-22 <br />