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J aroreors.aurornio--EnvironmentalP+ofectian Agency Form Approved OMB No.2050-6039 fExoires 9.30991 I Pfeose print or type. form designed Far use on eli�ell2-p� 5@@ fI1SIPUCtIQs 7g9 b. writer. aporpnent of Toric Substonaet Centre 1. Generator's US EPA 1D No. - ,1 _ &Cromento,ColiFornia UNIFORM HAZARDOUS Manifc. I! smanl No. 2. Pelta t fnfotmction in tf,e shaded areas WASTE MANIFEST _ is not r _ equired by Federal law, a I=: - of w {' 3. Generator's Name pnd Mailing Address I ?'} r C _ i A $safe AAantfesl Dacun+Cnf r '4 f'IF1. i ! I)r^, � !-.FIW Tf.i! liJi II 41` r E 7sy ti�S � i-b r ';` �1G!"tk�:��'�',-t -$c�►r �.' f +w TIP, ! t l .�.:r t= LO d. Generator's Phone ( •r-.• -1 n B. SfataGanesaiOlttlb � .. Y ,� ' '• [ .5. Transporter 1 Company Name co 6- US EPA ID Number T r'•!�- I ;-1 T I_ li G{S►ataronsportalsfll !",A-Wt', t 3 } s< D: Trans ers 17, , - IE paA frlroeiQi� fit! -„ r 1?1 7. Tronsparter 2 Company Name TI J S. US EPA ID Number �E 1Staie Tra,i N 7 a sppreers!Q rj N. NU 'Q —— f I It F: i+ans artse Pbram `VU 9. i esignared Facility Nome and Sirs Address P. - f t li l0. US EPA ID Number li G;Stain Fadi iyti Fp 'trC r.- ;.i {:, _ { " { k MZ _ r 00 M?FaptUts W W I�'�3fJ (=� !- ! !" I..� ':?�+'_s�,J"� , i:; $ :"', f-; rw �y .� ]�-t-- t 1-t&(�'�•c��h 'rt. - � " 4„ Ov U i 1, U5 DOT Descr,ptior,lincfuding Proper Shipping Nome,Hazard Class,and ID Number) _ 12. Containers 3. 'ofol 14, Unit q s .`. ?? , Z a. No. Type Quantity Wt/Valr4 I••IF11'-I—F'c -:r-r L-j:)'ZAl=:r,r7w :,'w i I_I,a�Lj I L' �,.�. E ! I �, Q Nb: � ',��_ eco E A VW CO O Z LU 1 !. Addiiionni Descriptions for Materials Listed Above ! E I fr 0 tC Flandfsnq fades 6or Wastes Vs 'Asher. h y {#s _ r i.• V) k=?N5 AT LU A }fir r rf�'c Q i i$. Special Handling Instructions and Additional Iniormation a ;AI='i"•I�'i]t"-�I i �rE I='i�i�3�1:'. I"T'�E i-t__n r�'�.r• r Z W EIKIEPI. =EE. E. F:. ��. 1 �" Q16. GENERATOR'S CERTIFILATION: I hereby declare that the contents of this consignment are fuiiy and accurately described above by proper chipping name and are efassiffed,pocked, imarked,and labeled,and are in all respects in proper condition for tra sport by highwoy according to applicable:nternotional and notional government regulations, If I am a large quantity generator,I certify that I have a proram iq piece to reduce the volume and toxicity of waste generated to the degree I have determined to 6e ecanomicaily practicobfe and that I have selected the rracticoble method of treatment,storage,or disposal currently available to me which menimizes the present and future threat to human health I and the environment;OR,iF I am a small quantity generator,1 hove made a good iaiih effort to minimize my waste geneiarion and select the best waste management method that is 0 available to me and that I can afford. �•. P ntetf/T a Na e r �I $i nature li g / G If Non. Dox, Year. w U C'C• . f 3 ! 17. Transporter 3 Acknowleclement of Receipt of Materials r� R ,j� R Printed/Typed Name Signature - Mon+ Dal' ea u�Ik P i�` t�f`I '"� C'14CT'7 , i [ n u-! 0 18. Transporter 2 Acknowled ernent of Receipt of Materials } (f Q ?'i !e Typed Name ' �. - Signature w E Month Day Y*r.. it Q O v U 19, Discrepancy Ind icotiun Space �. F r. z A C L if 1 20, Facflity Owner or O erutor Certification of receiot of hazardous mnteriuis covered by this manifest oxce t as noted in it 19. Y i rioted/Typed Name Signature !C Mantft Day Year -. [ I r DO NOT WRITE BELOW THIS LINE. OT5C 8022A (4/971 EPA 8700-22 Yellow: GENERATOR RETAINS tar ;�