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hl { — <br /> See Instructions on backw V ioe c. Depar!men,at lar saa,tanr=•can!ra <br /> ple_ss pr _ r Ps 'des g ro u,c a n I'ts(12-Pik`�wRter. Sacramento California <br /> L 1. Generator's US EPA IG No, Manifest Document No. 2 Page I Information to the shaded areas <br /> ri UNIFORM HAZARDOUSn!rege.ed by Federo!Iovr. <br /> - WASE MANIrEST - .. f- <br /> r l l i of I <br /> '. Gera^ear•Y.me cmd-ysxs.iir,Across,, i A. 9a I.Momfesi DocvmeNNum6e <br /> I n tt <br /> r B. Srote Gmeromis ID <br /> o I <br /> h4. Generators Phone - <br /> IQ <br /> r 5. ransporler I Company Name 6. US EPA ID Nvmbar C. gate Tmnsponer's ID(Reserved.) <br /> h <br /> D. Transporrer's Phone - <br /> 0 <br /> O <br /> OF 7. Transporter 2 Company Name 8, US EPA ID Number -E. Stale Tronsporfer's 10[Reserved.] <br /> _ F. Transporter',Phone - - <br /> VSt._DesiB a1 d Facil"aY Namerd Site Address 70. US EPA ID Number G. 9ota Facility's ID <br /> a'`9 /,. .. r ;: Fr °r •�' 4 (^ - H. Facility's Phone h. <br /> -; Q 11. US DOT Description Budin Proper Skipping Nome,Hazard Class,and IO Number) 12. Containers 13. Total - 14. Unit - <br /> sP'/,U P fi^ 9 P PPin9 No. Type Qaanfity Wt/Vol I. Waste Number, <br /> state <br /> - e_.- 1 <br /> '° <br /> , EPA/01h <br /> 10 <br /> r E b_ State - <br /> o N <br /> co E EPA/Other <br /> e R <br /> v A state <br /> o T <br /> C0 0 EPA/Oiher. <br /> R <br /> w d. sme. <br /> Z <br /> Z <br /> ts,l EPA/Other <br /> v <br /> 'o J. Addit I Descr' tone fo Materials ted Above K.-Handling Codes for Wastes Listed Above <br /> a_ <br /> N <br /> w <br /> a <br /> a <br /> OZ FS.ISpec f Handl ng4c,"d d.Add fos of Information <br /> �. ,.. <br /> 09 38 <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consig mart are fully and accurately described above by proper shipin,name and are classified,pocked, <br /> Q moped,and labeled,and am in all..specks in Proper condition-Tor transport by highway according to applicable international and nation government regulations. <br /> U <br /> J If I am a large quantity generator,I certify that I have a program in place to rZdaca the volume-and toxicity of waste generated to the degree I have determined ko be economically <br /> H practicable and that I Use selected the practicable method of treatment,storage,or disposal emrenlly available to me which minimizes Ike present and future threat to human health <br /> and the environment OR,if I am a small quantity generator,I have made o good faith effort to minimize my waste generation and sale&the best waste management method that is <br /> O <br /> waila6le to me and that I can afford, <br /> y Pfmled/Typed Name Signature l Month DaX Year <br /> Z P-4lt r,/)yrt„?} 'r..P'`! �,;` ` .�,.-5r�” I .� tJ 4 <br /> w T 17. TraOar I Acknowledgement of Receipt of Materials - <br /> acns Month Day <br /> R N .,,-, t_ __ S" t rem Y Year <br /> w Pnmed TypedQ/11y„) 9fes' i L7 <br /> 0 1B. Trons rlar 2 Acknowled emeni of Receipt I Maha;snsJ F <br /> O R Printed/Typed Name Signature Month Day Year <br /> T <br /> w E <br /> � R <br /> V19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> ( 20. Facility Owner or O rator Certification of receipt of hazardous material,covered by this monifesl--cap'as rated in Ilam 19. <br /> T Printed/Typed Name Signature, Montle Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC.WITHIN 30 DAYS. <br /> DISC 8022A(1/99) To: P.O. Box 400, Socramanto, CA -95812.0400 <br /> EPA 8700-22 <br />