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State at Calitornia—Environmental Protection Agency Form Approved OMB No.2050-0039(Expires 9-30-99) See instructions on back of a Oa9 6. Pleaselprintbr type. Form designed for use on elite(12-pitch' 'writer. Department of Toxic Substances Control Sacramento,California UNIFORM HAZARDOUS anerator's US EPA ID No. Manifest Documem 2. Page 1 Information in the shaded areas WASTE MANIFEST I is not required by Federal law. of 3 Gen c fors Name and Mailing Address A. State Manifest Documen Number �j[ p .4 Y <.. l.!^ a{,at.:'x: Wyk + "r .,, y':i..,zp 6,..,�; Fe 13 O '1 B. State Generator's ID J. Ge,erafor's Pbone I �.� p' 4r .,J t.F(y r Fff.e'3 - s .•x (V 5. Transporter 1 Company Name 6.SUS EPA ID Number C. State Transporter's ID(Reserved.] LO C O D. Transporter's Phone O ao . 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved]- J kQ F. Transporter's Phone '°q V 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID Z s N. -Sj O H. Facility's Phone dA -1 i'` ! 14 - >Y� & '•!dt Q 11. US DOT Description(includingProper Shipping Name,Hazard Class,and ID Number 12. Containers 13. Total 14 Unit V p p pp g ) No. Type Quantity Wt/Vol I. Waste Number a ' 'x Y �TJ...3 'p' State G EPA/Other O N 6. #4•;31 it..6ri [ 3'n?;.iC,1-rt.S'.iUr;v:it:r;a,. :>C. � Ji:l 1, iT7"?:,1 $Y:1.3nd;4i r5"' State oo oo E -4 R EPA/Other v ('r A �b ta' t T;, _ rd O T ` State co O R EPA/Other Lu d' State Z Lu U EPA/Other Lu ZJ. Additional Descri tions for Materials Listed Above K. Handling C des For Wastes Listed Above is b V) ° t qv" Lu c _ c. d. Q Z O 15. Special Handling Instructions and Additional Information � � ;l•. .�i"' X. ".... _fly�C.r'S.f::�.e. Z1!�'?S_tt: i!3$t:., ttli.'."q' t ti.,.•:(:'>. ;'ati6tlk,a:'a<. Y,Ysiy+Y't ,3 `l0 .. Lu 2 Q16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, U marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. J 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,storage,or disposal currently available to me which minimizes the present and future threat to human health a and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is 0 available to me and that I can afford. >- Printed/Typed Name 4.Signature� Month Day Year Zea `... s^W�.Y...aP,es .� •��- Pr°a , "IN` .,.<� ''� »+ K .. w w. T 17. Transporter 1 Acknowledgement of Receipt of Materials w NPrinted/Typed Name Jf t Signature s v"? >r Month Da Year S y W a 0 18. Transporter 2 Acknowled em ant of Receipt of Materials ✓ R T YP Name Printed/Typed ed N 9 nature Month Day Year LijSi LI) E Q R U 19. Discrepancy Indication Space Z F A C 20. FqciJity Qwner or Operator Certification of rejzeiptof hazafdous "i Is cover•8d b this manifest. e't as wted in Item 19.. T Print d/,T ea Name C;.a V. t 9 YP j n 1! z. Signature „ ,, Month Day Year...., Y 1 !,K•. d6 4 i E� DO NOT WRITE BELOW THIS LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. DTSC 8022A (1/99) (Generators who submit hazardous waste for transport out-of-state, EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.)