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i State of Colifornio—Environmental Protection Agency ~,` - Form Approved OMB No.2050-0039(Expires 9-30-94) Se Instructions on back c e 6. beporiment of Toxic Substances Comrc Please print or type. Form designed for use on elite(12pirclr, inter.-- :,�, Sacramento,California i I UNIFORM HAZARDOUS 1• Generators US EPA ID No. Manifest Document No. 2. Page ] Inareas formation in the shaded i is not required by Federal law. WASTE MANIFEST (� P.oi CZ (� ( r�, w of f % I 3- Generator's Name and Mailing Address 3 L Cud! i i� f' l_ ��'" A: State Manifest Document Number p 1-�1�++.�1� 1--F[-CZ ti`�-t 1�C.'(V l�C'� �x��- �tom: �� ,. ; 63 5 s LO 3C�LI L- . LQ ✓r r� 4 ui r ..-S J L - s B State Generator's 1D X ? � C CID Le) 4, Generator's Phone (� •-} L _s p 5. Transporter 1 Company Name 6- US EPA ID Number C-'State Transporte'r's ID00 i 7 r D."Tr 77r's Ph�ne fi 9?J 7. Transporter 2 Company Name 8. US EPA ID Number E., State Trams porter's ID 9: Transpor€er s Phone j , _ 9. Designated Facility Name and Site Address 10. US EPA ID Number G- State-Facility s IDZ 4A 70 C' iLtk_ '. t'-'L:Lt [L H. Facility's Phone" ac r 1I U 12. Co Diner 13. Total 14. Unit 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) " ? Z No. T e Quantity Wt,Vol I. Waste Number 3 a- t- . cJ� il�Cc lDIC UCX V N ; bPA Other G LI j�1 "tit ,.. (:1 / s C` E co N b. j t State 00 E N EPA/Other,' 3 d= a A :ts 0 C? T C. State 00 �%. EPA/Other ' R LU d I State 3 LLP i V EPA/Ocher LU --1 i°•X,- cn Z rt n'i for5 Mcri,r Ertrte.d Aswrb;oavcct 4�`fir: ass c» ' %A l'Handling Codes for Wastes`listed Above 0. y ��t ,�ty� b. � I "?..,� I_,.• 6 ks „a� ..£ S'sa 33'X' t i d. 4' _ t �' Cr a fi"L� qtr Z Q 15. SpecialHandting-.Instructions and Additional Information _ ? r� P ti� 1Q. UC'C� � ��F' l ' � �� 1, f�`• _ .�< <-,..r. 1 . " .z LLJ tl 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents c the consigrvm�nt are ully and accurately described above by proper shipping name and are classified, J pecked,marked,and labeled,and are in all respects in proper condition for trans ort b highway according to applicable federal,state and international laws. Q P P P P P Y 9 Y g U 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 I have determined to be economically practicable and that I have selected the practicable method of treatment,stor ge,or disposal currently available to me which minimizes the present and future I threat to human health and the environment; OR, if I am a small quantity generator, I hav'made a., od faith"effort to minimize my waste generation and select the best ! I waste mans emeet-method that is available to me and that I con afford. Q Printed/Typed Name 1 1 Signature .- ? ' Morth Day Year 7 17. Transporter 1 AcknowCed em Z e t of Receipt of Materials R s~ A Printed/Typed Nome," / Signature Month Day Year 7 / \ 0 18. Trans orter 2*1Y knowleclernent of Receipt of Materials ~� ? R Printed/Typed Name Signature I Month Day Year U_ R tw 19. Discrepancy Indication Space a � U A I Z I 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this m 3nifest except as noted in Item 19. T Printed/Typed Name Signature Month Day Year DO NOT WRITE BELOW TH15 LINE. j Yellow: TSbh SENDS THIS COPY TD GE`;E.4 If ',. .� = =1Y5 DTSC 8022A (7/92) (Generator; + :io submit .-x,.:;'3-j: EPA 8700---22 produce ccmyfete.. oilu, -f tris C.J.3v �0 days.)