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State of California—Environmental Protection Agency Form Approved OMB Na.2050-0039(Expires 9.30.99) See Instructions on Please print or type. form designed for use on efile f I 2-pQ v,Ier. 'y' Oeparepent of Teak Substances Contre itSacramento,California UNIFORM HAZARDOUS 1 Generator's US EPA Ip No. -Monifest Docum. 2. Page F informalie"in the shaded areas WASTE MANIFEST _ it not required by Federal law, " I 7. Generator's Nome and Mailing Address - _ �, - _ -- -- � I.A.i Stall 1'AatttFast poeunttesRi�fa' a •itp� r 'i��- t-•IENIG t,;lL ., I,;AT'-'PI_.0 1 I II10r _ F � �� z zf raw zs o rct12 E {'1h"t' F,L..(..f._I 4'C1Ft1) (! 1"'� �1�', . _s`s Mme.. . :1 11P. B.'i5lafeGo" rvls7r! s w Y x vt rte m: 4. Generator's Phone [ .. 'I :� -.1 1 ' c7 l 3 f°, N I1 5. Transporter! Company Name 6. US EPA 10 Number 'i! C. Slate Tra�tporteri ,y� i -' is 6 n_'T�_ I -;� ',_� '�— Lf { J� O I W i 1. i 9•-lTransparters Pfsone:it Z �' ;�' S I m _ 7. Transporter 2 Company Nome 8. US EPA ID Number -�I E State 7rcrosportes's tDF,�,It Q i F: inztnparter'i F'ftossi,c.' r {�`. •''� .sT�:,ls':• U N 9. Designated Facility Name and Site Address 10. US EPA ID Number t G. State Pact rfy'tt 1T)E. '!"_+ l. . Tal \'JO 1=N 1 1!'1G_ T„ 1 - ; z°•rtY ie p� //ya/am� - h.FanitiR'a Phot�t ,; -� • ' r t st• •rt✓r� .i F^I�`-�T1-1 ! Cri s' •ih_! i__ t _ ';i� a fE Q 12. Conra,ners 13, Total [d. Unit - :'i, '' a m� I i. US DOT Description{including Proper Shipping Name,Hazard Class,and ID Numberf a i No. Type Quantity Wt/Vol (j�'`�__�-'I. HA Ai'_.E 0l..S wi"S'T E I t. i. '. .tF..� . 'ii ^�t. L' if +Vr3 G A ti,)AJEf=: T<A Y ov t`" CIO E i o N b.00 S�add :�r i , 5n co v '�+( -+ C-4 R A coo O � � r LLJ I {J 9 r. IJah., 1•. Z }, Additional Descriptions for Materials listed Abe" K_HoncIIIAg Codes for Wastes `tad 0 J - t . f U. ; u i' rb- .'`�-.£r t1_ ,¢ ��r';a2 ,•� IES, tr'S �p 6 i - riu i •f di: d'3„Ay+ 1:4+�iktT. ery O 15. Special Handling Instructions and Additional Information [. 'Z '+ int Ci'`' 'iFj�}` _ !T I"I I'';�I tat_. r .....t•s` ,} _i -•.�'�•.i`'ir s'y T :E r. r' - 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fuily and accurately,described above by proper shipping nomo and are classified,packed, Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. zy J I If I am a largo quantity generator, I certify that I have a program in place to reduce the ,olvme and toxicity df waste generated to the degree 1 have determined to be economically Npradicaale and that I have selected the pradicable method of treatment,storage,or disposal currently available to me which minimizes the present artd future threat to human health and the environment;OR, if 1 am a smolt quantity generator,I have mode a good Faith effort to minimize my,viaste gen'erntion and select the best waste management method that is ne ! ovoiioble to me and that I can nPord. 11 QP'nrei��/^ e Name r 4 Signature .•` Month f D f^�Year L ( ,. T 17. Trans orter 1 Acknowled ement of Receipt of Materials R w A Printed/Typed Name SigrtatuU.1 IZ: i ra % Mo Dayna- R P U_ a 18. Transporter 2 Acknowied ement of Receipt of Materials It T Pri tedl/7aNa e _ ".� 'i ,r Signature ` a Month Day YqT v-'i R Q U i9. 0iscreponcy Indication 5poce Z F A C 1 h . I 20. FacilityGwner or O erator Cerriiication of receipt of hazardous materials covered b this manifest except as noted in Item'19. T Printed/Typed Name Signature :E Month Day Year { Y ' DO NOT WRITE BELOW THIS LINE. DrSC 8022A {4/97) Yellow- GENERATOR RETAINS EPA 8700-22