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stateSee kns`ructions o. beck a^ 6. Te,r as axcsabslances Contra <br /> Far'. c. 2 On. N- s J ' - r J <br /> Pleas-print a !"Pe rr de.'gvd h ase n.el.e Pilch;(I Zrifen V Sacromemo,Cal'lornia <br /> I. Generator's US EPA ID No. Manifest Document No. 2. Page I In{ormafian in rhe shaded areas <br /> UNIFORM HAZARDOUS i _ �na ed by Federal lo <br /> WASTE MAN(FEST I i 1 -1 i I I I I I• I of w. <br /> nd A. ,q Add <br /> 3me ar-es.. - A. Stole M n,lest Docume, Numbe <br /> . Generator's Na -` <br /> - - - - - - 8. State Go ...to,I ID <br /> o i <br /> N4. Generator's Phone I - <br /> n <br /> N 5. Transporter I Company Name 6. US EPA ID Number - C Slate Tmnsporter's ID(Reserved.) <br /> h <br /> -: - - -' • - ' _-: - _ • D. TransporfeJi Phone <br /> 0 <br /> C, 7, Transponer 2 Company Name 8. US EPA ID Number E. Slate Transporler's ID(Reserved.] <br /> F. Transpoiter's Phone <br /> J <br /> .9- Designated F.61r,Name and Site Address 10. US EPA ID Number G: Late Facility's ID - <br /> s H.' Facility',Phone�� _ s" rk � i li 4` a w. a . s� -5. '•v�� 'Y'iF�:s <br /> PN.. <br /> t6inen 13. Total 14. Unit <br /> '1 V 13, US DOT Description pncluding Proper Shipping Name,Hazard Class,and ID Number) Type Ovontity Wt/Vol 1. Waste NumberZ Late 'r } EPA/Other -GEStateo N rbr: _ �e..f�'a''Fs`!EC'4sJo ?in00 <br /> `j,ms�sQe } V �, -. EPA/Other <br /> V <br /> V A ns :z a- i 5G.=.• F` State <br /> o T Latjsaeve`' i c ±.i.s ' rf Lri$1 txv R.,. t ' 3I <br /> call O r = v rr EPA/Oher <br /> R <br /> w std. i .F .i i=F, < e 4ti; =c� '�. Gil <br /> ball <br /> Z - t .T ttyJ. `i4 f9 �; 1 r�! - .EPA/Other <br /> U <br /> W <br /> Z9 jtdiiti,nclpf}a,po nr F CM terrpslaisled Above K, Handling Codes kr Wastes Listed Above <br /> / ( :7 a b0 or . <br /> w4�' ea �7'T- ')F <br /> z r o . m _ d. <br /> Qey�5:5paa af"H nsllmgln`h4ct pvand,,Addtt al Information <br /> Z <br /> sLo <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare That the contents of this consignment are fully and accurately described above by proper shipping name and ore classified,packed, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and notional government regulations. <br /> J If am a large quanfity generator,I certify that I have a proggram in place to reduce the volume and roxiciy of waste generated to the degree I have determined to be economical[ <br /> d racticabte and than have selected the practicable method of irwlmenl,storage,or disposal Sumently ans oble to me which minimizes the present and fulcra threat ro human health <br /> and the environment;OR,if 1 vat sr small quantity generator, have made a good faith effgn es minimize my waste generation and select the best waste management method that is <br /> W r available to me and that 1 can afford. <br /> I ( ` <br /> U Prin ed/Ty�^ �7 f-' I�Yp:P'1 �i ` SignaNra i % ' .T, s i De/ Year <br /> - "- <br /> A I1Y YI-' aJ <br /> Z J �� \ <br /> 3 T 17. Transporter I Aclas lodgement of Receipt of Materials <br /> s6lJ' j Printed/T,ped NomeCy— t Da Jeoµ,;r <br /> w 5 : <br /> _ P <br /> 0 18. Tran Her 2 Acknowledgement of Receipt of Materials <br /> 0 R Printad/Typed Nome SignaNre - Month Day Year <br /> 1 <br /> w E <br /> sn g <br /> V19. Discrepancy Indication Space <br /> Z F <br /> — A <br /> C <br /> I <br /> L <br /> 20. Facili Owner or O rotor Certification of recti t of hazardous maroriab covered this manikst exce t as noted in It..19. <br /> T Prinled/Typed Name Signature Month Day Year <br /> �— DO NOT WRITE BELOW THIS LINE. <br /> Blue: GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS, <br /> DTSC 8022A(1/99) To P.O. Bax 400, Sacramento, CA 95812-0200 <br /> EPA 8700-22 <br />