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tjirate of%.autorma—tttvtronmentat rrotecnon Agency <br /> Form Approved OMB No.2050=0039(Expires`9-30-99) See Instructions on back oLmmoe:6. Department of Toxic Substances Control <br /> P Please:print or type.,Form des(gnad for use on elite(12-pitch riter. <br /> ' = Sacramento,California <br /> UNIFORM HAZARDOUS 1• Generator's US EPA ID No. Manifest Document No. 2.Page 1 Information in theshadedareas <br /> WASTE'„MANIFEST y <br /> is not required by Federal law. <br /> Of <br /> 3 Generator's Name and Mailing Address tib qtr 4 <br /> 1; 101..I'S Go, �/ nLO <br /> Ln <br /> 4. Generator's Phone a. w <br /> f <br /> Et 2001 <br /> sN 5. Transporter 1 Company Name , US EPA ID Number <br /> co F <br /> 0 a�,iT9d +M .itk fi...a°Tf tidt P'� il} r�4f'k$$S�'!s �t fLA <br /> aD <br /> 7. Transporter 2 Company Name <br /> 8. US EPA ID Number <br /> CAD <br /> V 9 Designated Facility Name and Site Address 10. US EPA ID Number s <br /> Y <br /> " < 12. Containers 13. Total 14. Unit <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 1 <br /> r_4 V No. Type Quantity Wt/vol , <br /> Z a. <br /> Non KFM 14aZaMOUS Wsle 30id <br /> 3 G c”,ka <br /> NN0 b. <br /> °D <br /> ao E <br /> ¢. <br /> 74 A <br /> v A � <br /> C. ANGELES, CALIFORNIA AS THE 11 ' <br /> co o <br /> R APER PRA ER iT T E EI E OUR <br /> LU d' <br /> W <br /> NUMB R IS CA 08003 681 <br /> ud t <br /> LU <br /> a�(j4 nl tci t �'i 'w v t <br /> -� �� '�a^.r•<.r� �+{r��l*u�i��` i1uI�4�� ryrn� �����k �; _ -, �"��' -, 3 �. r 7 (��'A� . <br /> 0 �15Special ryHandling pInstructions <br /> ,and <br /> p,Additional Information � r <br /> Q {,,,+' <br /> Z )" dc'Ii?1-• `i.I'{ JobLU <br /> 23".VI E. d"'t..t,:s 1D(-4) <br /> 16, GENERATOR'S CERTIFICATION: I hereby declare that the contents of thisconsignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> V marked,and labeled,and are in all respects in proper condition for transport y highway according to applicable international and notional government regulations. <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 1 have determined to be ecanomically <br /> h practicable and that I have selected the Practicable method of treatment,storage,or'disposal currently onRilable tsr me which,minimizes the p ent and future;threat to human health <br /> and the environment;OR,if I am a small quantity generator,I have made a good faith efPdrt to minimize,�y w tie generation ands lect the b t waste management method that is <br /> O available to me and that I can afford. <br /> y Printed/Typed No" yt-gg �rs r a Signature ^` Month Day Year <br /> W FJs k t f' V <br /> Ur T 1 sporter 1Ack owl nt of Receipt of Materials .r"f - ' f •. "*„ <br /> U.1 p `Pri d yped Name rna <br /> � <br /> S S Month DayF, Y r <br /> w Rl ` { - <br /> LL_ 0 18. Transporter 2 Acknowledgement of Receipt of Materials fi <br /> d i Printed/Typed Name Signature ^' <br /> w Month Day Year <br /> E <br /> Q R <br /> U 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> ( <br /> L <br /> I 20. FocilitK Owner or O erator Certification of receipt of hazardous materials covered bv this manif -exce noted in Item 19. <br /> S <br /> Printed t ed a i <br /> T YPgnature i t(vlont� DaAy Year <br /> DO NOT WRITE BELOW THIS LINE:' <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> DTSC 8022A(1/99) (Generators who submit hazardous waste for transport out-of-state, <br /> EPA 8700-22 produce completed copy of this copy and send to DISC within 30 days.) <br />