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S1ans of Calilenm—Environm•nal Protection Agenry <br /> Form Approved OMR No.2050-0039(Espiraa 9-30-991 See Instructions on back of page 6. Deparnaenr of Toxic Sabstarom Co.*.. <br /> PI•ow prior or type. Form designed fen vee on alio(12-p;ah1 y be Saezamamo,California <br /> UNIFORM HAZARDOUS • 1. erarols US EPA ID No. Manifest Document Na. _ 2. Page 1 Information in the shaded meas <br /> WASTE MANIFEST e( 6 e S y3 a g arrpmedby Federal lar. <br /> I <br /> of � I <br /> 3. Ge f raror's Name and Mailing Address - San Mmt fw0m:Am rrt Number - 't" y t <br /> zs.Ea �.aes .yet �� ":"�'� •;' ,� �,,� <br /> yoQ saD cs n'L H9ee k <br /> N AFIM)T"e""r. ^,�SlalaG•rwaloLe <br /> 53 8'i <br /> A. G•nerarols Phoria Co.CA. 9 <br /> I +•' <br /> N 5. Transporter I Comp°ny Name 6. US EPA 10 Numhr .(.^'.SlotaTmnspwbfslD pr-�;- m^ •'" T'` <br /> as <br /> 8 DFTw spa afi PI o a TSSJ*+.• r <br /> N � 7T / 7 tSY�{`'.i=F3�ia�".�-:, 'n' i.. 7f <br /> .. 57 <br /> 7. Transporter 2 Company Nam• - S. US EPA ID Number ,E`;,Slarw ranapab/i IO M <br /> Q ata^+ ,=.-x..+..�.-• <br /> tJ co 9. Designated Facility Name and Sin Address 10. US EPA ID Number 'SEolssFhaltt�ilDltAy, t, t.` <br /> CHEMICAL WASTE M iAGEMUNT, INC. tr' . ¢ �;aj <br /> 35251 OLD SKYLINE ROAD, $ET!'LEMAN CITY, CA 93239 t'�'?�`'P"° "' <br /> 1C IA IT lo In In 16 14L 116 IT I <br /> _ <br /> O <br /> No.12. Canninars - 13. Toal IA. Unit <br /> .(� 11. US DOT Description(ioduding Proper Shipping Name,Hazzard Number) / <br /> d Class,and ID Numi <br /> TY • ortity Wt,Vol FG say Nwniwa�� <br /> N= ° aQa � ►.+�zneevT.�s was}E 50c:.n - � - ty. . <br /> Cn3 G Epoty rnolD 'wmpa�D��E A) 6 <br /> 4.. <br /> m E <br /> .. a w.6 T ' •f • Tt Sajy <br /> m O am.- <br /> 1.. <br /> EPA/ORw:'�'p_ <br /> ad <br /> d. <br /> EPA/ d:N <br /> W - <br /> Z J.Addrhoral D.Acriphorp focMaenaG LsndVAfie.a �`�r' yt r d^ rr3 If�Hodlag Car{Fs Waslaluyd AEwe <br /> a <br /> ad <br /> 1S. Special Handling Inao%xinvand Additiaai aformah" <br /> ti Z <br /> HANT.LERS BE 40 HOUR OSiiA/SAdA`TRAINED - <br /> W AND USE NIOSH- APPROVED PPE- <br /> (916Y 916 371-5747 <br /> 16. GENERATOR'S CERTIFICATION: hereby daalan that du Canynh of this wnsiynmant an Fully and accurately d•scribid above by proper shipping nam•and ore d...i Iied,packed, <br /> marked,and labeled,and ain all respects in proper coedhion for zranspat by highwy according to ihnnad°nal and national govammant regulations. <br /> n <br /> If I am a large quantity9.w,1 certify that))Fane a.'-•r m in place:a�ad-isrwthe volumaad iazicityof wen generated to tfrd me I haysdetermined to be economicallsoy <br /> i practicable and that I have s•lecrod the pracncahlamelhodlraatmant,varog•,-w dispoal currently available ro ms.vhich:minimim the present ad leans threat ro human health <br /> std the enNronmanr;OR,if I am usmall aMi <br /> gu y.g.neraor,}1,`m•madla goodiaith effort usminimizew <br /> minimimy en generation and wiled eC the,bvasro management m•r6ad that is <br /> Oawikbl•se me and that 1 con vifbd. s' f' �K <br /> } Prin /Ty Noma Sigmnn 2 Month Dry Year <br /> z r [4P+^ 4.a ll I c c, �� .ted c <br /> IF <br /> Z5 ; 17. Trorn hr 1 Acknavd r of 0.•ceior of MaMids <br /> W M Prinnd/Typed Name S' N Mmrh Day Year <br /> � s <br /> W p <br /> W R 18. Transporter 2 Ac l r of Racei t of Monrids <br /> 0 I Printad/Typd NomeIRA <br /> n ✓ Mends• Day <br /> {aj 19. durepmtcy Indication Spon y. <br /> IF <br /> Z A .e' y - o <br /> I <br /> L <br /> 120. Facili O..nar o.0 rot Cwtifaadon of r•c•i of hammloua mnb <br /> ariacawed manifest miF•sr exc La <br /> Assent as named in Inco 19.-. <br /> T Primed/Typd Nome Signature A1•nda coy Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> • Blue: GENERATOR SENDS TIi1S COPY TO DTSC WITHIN 30 DAYS. <br /> DTSC 8022A Fd/971 J To: P.O. Bon 400, Saoamento, CA 95812.OA00 <br /> EPA 8700-22 <br />