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State of California—EnvironmentahProtection Agency <br />rm Approved OMB No. 2050-0039 (Expires 9.30.99( <br />ase onnt or type. Form designed for use on elite (12 -pitch ewriter, <br />C <br />r <br />�r <br />a <br />D a <br />LL <br />C <br />Q <br />z <br />C <br />a <br />Z <br />t - <br />a <br />L <br />See Instructions on back 0ge b <br />Department of Toxic Substances Control <br />Sacramento, California <br />DO NO�4RITE BELOW THIS LINE. ' _ <br />DTSC 8022A (1/99( White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />EPA 8700-22 To: P.O. Box 3000, Sacramento, CA 95812 <br />1 . Generator's UG EPA ID No. Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />UNIFORM HAZARDOUS <br />.is <br />I <br />not required by Federal law. <br />WASTE MANIFEST <br />�Y L I -5,131-5171V 7_ <br />of <br />3. Generator's Name and Mailing Address r� <br />n yc,- ,;c,� 7 <br />-A. State Manifest Document Number <br />22490620 <br />C, (� ^fir✓I r: i / - � <br />,✓7� J. y �4r�t 1' <br />B. State- Generator's ID <br />�r <br />4, Generator's Phone (T •J� ( f-+ - -! /If <br />_- <br />p Company <br />5. Trans orter 1 Com on Name 6. US EPA ID Number <br />C. State Transporter s ID f.Reserved.j <br />o1cgJIndustries ontrof <br />2 � 0 <br />7 <br />DFrans ortersPhonep <br />1 <br />7. Transporter 2 Company Name a. US EPA ID Number <br />kE State'Transpo,efar`sID. Reserved.]' - - <br />Transporter s?Ph?ne <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G StaterFaeiltty s I'D <br />ECOLOGY CO l7 �"L INDUSTRIES <br />2z -,v PARR ELVR. <br />H Facilityls Phane-. <br />D'Cwftan.n n r� 0p <br />' 1019 1416161319 <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 />1 W.osfe Number ;. <br />No. <br />Type <br />€ CN RCRA HAZARDOUS WASTE ,SOLD <br />G <br />( EMPTY STORAGE TANK PIPING) <br />1 <br />6 <br />i <br />1 n R'c <br />E <br />N <br />b. <br />Stare <br />E <br />ELAfOtFer r <br />A <br />T <br />state 4 t -. <br />O <br />,. <br />.'� <br />hEPAf©thee <br />R <br />d. <br />State r <br />fEPA/Otler <br />S Addttonaf �scet tions %FMgtectasrNisfedtt`,46®v�'aridltts�xC'odaoipf'a <br />., . <br />'c`� ., u .,CuteeiaAbove°s <br />gster <br />i ti. <br />, <br />d>t <br />WMITk, <br />.0 Qd ` r?rn -,:, b v <br />xa „tr„ Y H <br />S. Special Handling Instructionsand Additional Information <br />- ear proper protective equipment while handling. Weights or volumes are approximate. . <br />24 hour emergency number. <br />24 hour emergency contaci�r`1' -7 (� / ECI JfN Z <br />7' -j <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, packea, <br />labeled, in in for transport highway to international Fions. I <br />marked, and and are all respects proper condition by according applicable <br />and national government regula <br />If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I hove determined to be economically <br />practicable and that I have selected theracticable method of treatment, storage, or disposal currently 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 />my waste generation and select the best waste management method that is <br />available to me and that I can afford. <br />Printed/Typed Name <br />Month Oay Year <br />4u4re <br />T <br />1 Trans arter 1 Ac nowled ement of Recei t of Materials <br />R <br />p <br />Printed/Typed me <br />: Ski-tr` <br />Sign re <br />/� <br />Month Day Year <br />P <br />,;,L F"3 <br />.'1c <br />�J+./ <br />e� 17 <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />A <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />E <br />R <br />19. Discrepancy Indication Space <br />IF <br />A <br />C <br />I <br />L <br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as <br />noted in Item 19. <br />T <br />Y <br />Printed/Typed Name <br />Sig tune <br />Month Day Year <br />I3 <br />DO NO�4RITE BELOW THIS LINE. ' _ <br />DTSC 8022A (1/99( White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />EPA 8700-22 To: P.O. Box 3000, Sacramento, CA 95812 <br />