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Stene of CoOornio-En�ironrn-daf Prolechon Agency <br /> turm Aoproved OMB No.205D-M39(Expires 9•30.961 See Instructions on back of -le bll ! Depon-e t of Toxic Substonros Cnnr <br /> P!nxse orw or type. Form designed for use nn elite(12Fitd, .-iter. �J(]' -'�- Sacramento,Cahfarrio <br /> 1. enerntor's <br /> 165 EPA ID No. _t land-=,r C xument No �T 2. Page 1 Informsttion in the shaded areas <br /> UNIFORM HAZARDOUS ' - (� �•f is not required by Federal law. <br /> MANIFEST <br /> ANIFEST �C (� G• �� �F` I!_ �uf ��ii >' . ' 1 ! of <br /> 3. Generator's Name <br /> -and <br /> fM*,hng Address <br /> l- A Stoto Aiantfest.t}ocvtrsent t3vmber��t �VtrR a t� i2 t <br /> LLL r\'�•..' ��� ,.,V e r a9...S �+�retc 9{' rrrrj E- <br /> l k fr 2^ `�� e•7 r >•?-{' 1/(� - Y c'�'r +c_ �- x, �✓.,?+ ye �, ,:L <br /> GenetWai IDst <br /> 5. Transporter 1 Compony Name 6. US EPA ID Number - - C State:Tro rs IQ 3P LIQ olds ,*T e� r1r <br /> �•y D Tran rt r S-PhorsC <br /> 7. Transporter 2 Comoany Nome 8, US CPA ID Number E. Stato•Traniporlct's ID r � rx� <br /> Q F- Transporters-se <br /> ransporters <br /> 9. Designated Facility Nome and Site Address 10. US EPA ID Number G. State Facility s'ID <br /> = <br /> H. Facilw-s A-- <br /> < <br /> ho <br /> 12__Containers 13Total 14, Unit11. US DOT Dacri tion(indmd;mq Proper Shipping Name,Hazard Class,and tD Number) <br /> r r <br /> G�Qnary WI/V.1 j Waste:thiittber+' <br /> -J .,._' I � I t If' SPAT f <br /> c [ b, — ---- -_�_�� state <br /> R l t EPA/Other. <br /> Stale . <br /> I i i EPA/Other <br /> t-. - d. •-- - •------- ------• -----------.-..------�--�-�_r_.._�--..._..I---1—_).__�. F_._....� Siwe , <br /> 1 I i 1 <br /> h; i EPA/Other <br /> J. Adddional Descriptions for Materials listed Above A K. Handling Codes for Wastes Listed Abouts <br /> 1tV �_G.L'Vty St6r c1C 4--,'T iz"ICt <br /> -1 wit! �!: <br /> . .i1L-V Ice. Psi 11: J.G��puri'tea tzlt:y. t �. d <br /> is <br /> 15. Special Handling Insirvctions and=dditionnl Informotion --- <br /> 16. GENERATOR'S CERTIFft_AT10N: I hereby declnro that the contents of this consignment aro fully and accurately described above by proper shipping risme,and are clossified. <br /> Q. packed,marked,and labeled,and are in oil respects in proper condition for Yransport by highway according to applicable international and national government regvlotions, <br /> U. <br /> If I am a targe quantity generator, I certify that I 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 method of frCa:'menf,Storage,or disposal currRnlly available to me which minimizes the present and funsrc <br /> v7 threat to human heakh and the environment;OR. if I em a;mall quantity generator, I have, mndn a good faith effort to minimize my waste generation and select the best <br /> s waste management r. shod that 4 available to me and that I can afford. <br /> • ; Printed/Typed Name i Signnture-r Day vYear <br /> j Month <br /> e I I, i7. Transporter I Acknowled emeM of Receipt of Materials - _-- -- _.-- <br /> Lu R -- --- - 9e <br /> ' ted/Typed`fa i Sign re\ i —t \1o,n Day Year <br /> 4 18. Transporter 2 Acknowledgement of Receipt of Moteriah � —•_- ,_,i - ---_---- <br /> T I Printed/Typed Name Signature L7. <br /> Day Year <br /> F <br /> H <br /> 19. '.'iiscrepancy Indication 5ao[e - <br /> i A �� I <br /> Z_t C <br /> 1 20. Facilitv Owner or Ocierator Certification of receiat of hazardous materials covered by this manifest exceot as noted in Item 19.— 1 <br /> T Printed/typed Name 1`712 Sign sn!r/- - Month Day Year <br /> Y - t `4L:• tt� f f r- Svc. �/ r✓" <br /> DO NOT WRITE ELOW THIS LINE. <br /> ,)TSC 8022A (1/95) - - - - <br /> 8700--22 <br />