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Slate of Colifornio—Environmental Protection Agency <br /> Form Approved OMB No 2050-0039{Expires 9 30 991 See instructions on back ofa e 6 <br /> Please print or type form designed for use on elite(12 pitch)typewriter Department g Department of Toxic Substances Control <br /> Sacramento California <br /> UNIFORM HAZARDOUS I Generator s US EPA ID No Manifest Document No 2 Page 1 Information in the shaded areas <br /> WASTE MANIFEST oe is not required by Federal law <br /> 3 Generator s Name and Moiling Address A'f tai 'tF u e i u <br /> Al/1Pepe,S /)ra/pvf-It t,I <br /> B S ! <br /> ' LO 4 Generators Phone <br /> fV 5 Transporter 1 Company Name 6 US EPA ID Number Sfa° s a ""'ID esei3`e� <br /> m { <br /> 1 71s <br /> r <br /> I � 7 Transporter 2 Company Nome 8 US EPA ID Number �-� ns ID jfCe e <br /> J I Pix Transpo`0 P apa"y ry r � �"sl <br /> CV) <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number G"State Facr ify 3 Z <br /> LOO <br /> A <br /> �# H_Facih 7 P on�j° 9 _ <br /> �7 <br /> V11 US DOT Description(including Proper Sh:pping Name Hazard Class and ID Number) 12 Containers 13 Total 14 Unitx <br /> No Type Quantity Wt/Vol r-, AF'g"�to a <br /> cz a <br /> = NON Fi(`W r"A,"APr1t0e1:le, Vat.lsS"t F t tn!l+f) rto' <br /> 3 G t V s3 ti . 1 y F`;y Y <br /> EP <br /> C14E <br /> Qrhe ,� <br /> ct <br /> t00 <br /> o E Sts <br /> w <br /> N R E C1t} <br /> v A ti <br /> 0 7 sro <br /> 00 O Ra <br /> R <br /> ' d <br /> zLU <br /> ~ 5m <br /> Z <br /> w <br /> Lu PA <br /> 1 ,Addifiooal Dec ite0"s{dry fertafPtedrW6n11,1Wasfefrb Lu <br /> - `d4T k <br /> 15 Special Handling Instructions and Additional Information r <br /> z <br /> f'S-1f'smC ,r Ce y i "� Fs1�� p sr <br /> 2 <br /> 16 GENERATOR S CERTIFICATION I hereby declare that the contents of this consignment are fully and accurately described above by Proper n9 name and are classified packed <br /> Q marked and labeled and are m aft respects m proper condition for transport by highway according to applicable international and national government regulations <br /> ' V <br /> If I am a large quantity generator f certify that I have a program m place to reduce the volume and toxicity of waste generated to the degree I have determined to be econamically <br /> practicable and that I ave selected the practicable method of treatment storage or disposal currently available to me which minimizes the present and future threat to human health <br /> and the environment OR if I am a small quantity generator,I hove made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> 0 available to me and that I can afford <br /> ' OPrinted/Typed Name Signature V ure �� 7 month Doy Year <br /> Z � r r� <br /> w T r <br /> (� 17 Transporter I Acknowledgement of Re f of Motenols r <br /> R � <br /> W5 Printed/Typed Name,� I \ Signature l / Month !Day Year <br /> I.L.LLj <br /> B 18 Transporter-2 Acknowled 'ement of keYeipt of Materials "' u <br /> TPrinted/Typed Name <br /> w E Signature Month Day Year <br /> ' to A <br /> V 19 Discrepancy Indication Space <br /> z F <br /> A <br /> C <br /> I <br /> L <br /> I 20 Facdity Owner or Operator Certification of receipt of hazardous materials covered by this manifest exce t as noted in item 19 <br /> TPrinted/Typed Name Signature Month Day Year <br /> ;@ <br /> DO NOT WRITE BELOW THIS LINE <br /> ' DTSC 8022A (1/99) <br /> EPA 8700-22 Yellow GENERATCIP PETAtNS <br />