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State Of Califarnra—Envtronmenlat Protectron Agency L <br /> Form Approved <br /> OMS No 2650-0039(Expires 9 30,99[ See Instructions on back of qqe b <br /> Neale p antype Form designed for use on able(12 pitch)47 er P Department of Toxic Substances Control <br /> ----------------- <br /> Sacromento California <br /> UNIFORM dAZARDOUS 1 �*enerator:US EPA ID Na Mani{esf DocumenF No 2 Page 1 Infarmahon in the shaded areas <br /> WASTE MANIFEST r(2 I(� '�f J ' I j r � is not required by Federal low <br /> 1 C� o� <br /> 3 Generator s Nome and Marking Address <br /> RAIN <br /> WyTE9 C aR W o-� A Stairs Manifest Document Nam}ter <br /> a mt'SSOi�WiaiYlOcS`�EWTE WASP <br /> ��958766 <br /> ' �09 146J-1 N^�'ECA, CA 95.3,36S Slate Generator s ID <br /> r7 <br /> 4 Generator s Phone <br /> N 5 Transporter I Company Name - <br /> N <br /> y # c 6 US EPA 1D Number h C State Transporters Q[Reserved] <br /> O ER.'GAN FV ALL EY ASTIE r-.1`" 41 g ,r" D iransportars Phone p�l��yy y+�e? <br /> Loa <br /> r 7 Transporter 2 Company Name 8 US EFA.D Number E State Transporters ID[Reserved] <br /> Q I I I F Transporter s Phone i <br /> LJ 9 to Fac No nd to Addie s <br /> b��AL 99R�f8 Z jj VO, INC ,6 US EPA ID Number G Stale Frac ley s 1D <br /> z 1)10 <br /> Mrs)�Qc Qc 7�sDO&S��ryyO�9rT�oO�j ST .irr�� �r �t H Fau�f3�lyrsy Phanep ��y <br /> r7s A lJlJ4 rF 2 J 1 0 562-MIS-W77 <br /> v <br /> V 1 1 US DOT Description(including Proper Shipping Name Hazard Cfass and ID Number[ 12 Containers 13 Total 14 Unrt <br /> Z a No Type Quantity Wt/Vol I Waste Number <br /> MON-CCR +HAZARDOUS S WAXrE t jQUjp State <br /> 221 <br /> t G (OILY WATER 0 Q T T �; EPA/Other <br /> b <br /> C14 E N <br /> ccState <br /> R <br /> v A I LPA/Other <br /> co O State <br /> 1 r R <br /> w _ - -- - --- _-- <br /> x _1 1 EFA/Other <br /> a <br /> LU f Stale <br /> V ^ I EPA/Other ! <br /> �I <br /> J Add:tranal DescnpHons for Mafermk Listed Abava � <br /> K HandhnG Cades for Wastes LisMr1 A]— <br /> a OiLr WAI-EN a I h I <br /> LU <br /> ,Y <br /> a �15 Special Noodling Instrvchons and Additional - <br /> z <br /> GLOVES <br /> EMERGENCY PHONE 20,9-667-8851 <br /> Q16 GENERATORS CERTIFICATION I hereby declare that the contents of this consignment are fully and accurate) described above by proper shipping name and ore clossJi d packed <br /> V marked and labeled and are in all respects rn proper condition for transport 6 highway y ° <br /> p y g wcry according to applicable international and nohoaal government regulations <br /> J I <br /> 4 f I am a large quantity genergfar I terrify that I have a proram in place to reduce the volume and toxicity of waste generated so the degree I have determined to be conomicof]y <br /> �j practicable and that I have selected the racticable method of treatment storage or disposal currently available to me which minimizes the present and future threat to human health <br /> and the anvironmeni OR .f I am a small quantity generator !have made a good Faith effort to minimize my wade generation and select the best waste management method that is <br /> Q available to me and that I can afford <br /> } Pr n /Typed Name { Sr <br /> r7A s y4o E#ti°f" g ,�r - -- --- - �._..._ Montt: ;ay Year <br /> w 1 17 Transporter 1 A emenf of Racer toF Mate ials /4wi".�r <br /> C7 it • .i <br /> ' w A Prmted/Typed lame Signahrre - <br /> LU R Month Do-, tsar i <br /> s P .. ! <br /> � P <br /> LL- 0 18 Frans aster 2 Acknawled emeM a Receipt of Materials ---- -- - , <br /> O T Fr m, Name — — ----�� --�-- _ <br /> Signature Month <br /> E Day Year <br /> R <br /> U 19 Discrepancy indication Space <br /> z F - <br /> A <br /> C <br /> --- - - -- <br /> 1 20 Facili Owner or O erator Certifrco4on of racer t pf hazardous materials covered b Ihra mpmfest ext t as noted m item 19! - -- --Printed ed Nome Signature ----- -n;h -— Y_-e_- <br /> Maday ar <br /> DO NOT WRITE BELOW THIS LINE <br /> r <br /> ' DTSC 8022A 11/99) <br /> EPA 8700-22 Yellow GFNERATCR RETAINS <br /> t <br /> .P <br />