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State of Colifornio—Environmental Protection Agency <br />rwrrmApproved OMB No. 2050-0039 (Expires 9.30.96) See Instructions on back of p< <br />PlisasZi pr n? - type. Form designed for use on elite (12 -pitch) type <br />UNIFORM HAZARDOUS VAC <br />Generators US EPA ID No. Manifest Document No. <br />WASTE MANIFEST 6 1 Lbbi I 1�;jjl <br />3. Generator's Name and Mailing Address <br />C�O WWT'tj ®4� SASS -j-0 <br />in <br />r' 22Z 6-• w C1361'r- <br />n���t�) C {� . �i 2 os <br />� co G <br />4. r s one <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />�Q <br />CJ <br />Q <br />Z <br />IxO <br />M Q <br />U <br />Z <br />3 G <br />N00 E <br />00 N <br />v E <br />Cv R <br />A <br />00 T <br />O <br />C, R <br />w <br />Z <br />w <br />U <br />w <br />V) <br />Z <br />N <br />w <br />ce <br />J <br />Q <br />O <br />Q <br />Z <br />W <br />1— <br />J <br />Q <br />to <br />O <br />u <br />Z T <br />w R <br />O <br />im <br />LU Sh <br />P <br />UJ 0 <br />It <br />U. T <br />0' <br />N <br />F <br />Q F <br />U A <br />Z C <br />I <br />I <br />1 <br />T <br />Y <br />7. Transporter <br />8. US EPA <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />_k s <br />`i 0 `) 14 i; 9 <br />11. US DOT Description (including Proper Shipping Nome, Hazard Class, and ID Number) 12. Contan <br />No - <br />a. <br />lie <br />C. <br />d. <br />�6 1-39Department of Toxic Substances Control <br />Sacramento, California <br />2. Page 1 j Information in the shaded areas <br />is not required by Federal law. <br />of <br />13. Total 1 14, Unit <br />15Special Handling Instructions and Additional Information <br />away '(- 1 �:;O It ,..r : L `in t i.:)t l , t�1� ays WNd2 ha.-(4--aw(-Lr L? an llil ] <br />I _ "4 �cI u VC TIsG!¢ ?f itiF2�36��(<j3 <br />16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, <br />packed, 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, I certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br />economically practicable and that I have selected the practicable methodtreatment, storage, or disposal currently available to me which minimizes the present and future <br />threat to human health and the environment; OR, if I am a small quantity g rotor, 1 hc7made a good faith effort to minimize my waste generation and select the best <br />waste management method that is available to me and thattl tam affor '� c7 <br />Printed/Typed Name ignatur Month Daye ear <br />17. TransWrter 1 Acknowledgement of Receipt of Materials <br />Printed d41ckrl <br />Signature Month Oay ear <br />18. Yran rtwled ement of Recei t o M rich <br />Printed/Typed Name Signature Month Day Year <br />19. Discrepancy Indication Space <br />P ' ted/Typed Name I Signatur I Month/ <br />DO NOT WRITE BELOW THIS LINE. <br />Day Year <br />White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br />DTSC 8022A (1/95) To: P.O. Box 3000, Sacramento, CA 95812 <br />EPA 8700-22 <br />