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Slate of California—Environmental Protection Agency
<br /> Form Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back of par-- 6. Department of Toxic Substances Control
<br /> Pkiase print or type. Form designed for use on elite(12-pitch)type
<br /> C,►?•'i•i�a V-O.r, I _ 7",, 7 Sacramento,California
<br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No, Manifest Document No. 2. Page l Information in the shaded areas
<br /> s not required by Federal low.
<br /> zdWASTE MANIFEST r- _ _
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<br /> 3. Generator's Name and Malinpp.Addrass ,t A. State Manifest Document Number ^ ^ ^
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<br /> O �0"5 '•ro i{*_r.•rlGJG.i 1:. LaL"t B. State Generator's ID
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<br /> A. - enefator"s Phone
<br /> (V 5. Transporter 1 Company Name 6. US EPA ID Number C. Stare Transporter's ID[Reserved.]
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<br /> °D 7. Transporter 2 Company Name `
<br /> p p y B. US EPA ID Number E. State Transporter',ID[Reserved.]
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<br /> F. Transporter',Phone
<br />!� 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID
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<br /> rQ 12. Containers 13. Total 14. Unit
<br /> W 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol I. Waste Number
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<br /> 00N 6-WASTE C1"'PP'031�M L100-1,J, ICIDIC, ORGLTIC, State
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<br /> ZJ. Additional Descriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above
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<br /> Q15. Special Handling Instructions and Additional Information T .-i�I-1� c't �-l�i(.�1� E'IF-F{-�1.i'lcy '#: (ti 0 0) 41;7;2--;3 7 i O
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<br /> = FLEET 52'?u riA^1 T/SE1P�'ICEl ;
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<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 are classified,packed, i
<br /> < marked,and labeled,and ore in all respects in proper condition for transport by highway according to applicable international and national government regulations.
<br /> 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 {
<br /> a_ practicable and that I have selected the rracticable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health
<br /> N 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
<br /> available to me and that I can afford. [
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<br /> } Typed Name t Signatur / Month Day Year 1
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<br /> to T 17. Trans orter 1 Acknowledgement of Receipt of Materials
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<br /> wA Printed/Typed Name Signature / /��' Month Day Year
<br /> s Aebc_ca Bowen
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<br /> e 18. Transporter 2 Acknowledgement of Receipt of Materials
<br /> TPrinted/Typed Name Signature Month Day Year
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<br /> tJ 19. Discrepancy Indication Space
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<br /> 1 20. Facility Owner or O eratoc Certifi 'on f recei f of ha prdous materials covered b this manife exce t as.noted�n Item 19. ato
<br /> T Printed/Typed Name s Big elute ' 'r tT -VO s `' on`tR a'y M ' ear
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<br /> DO NOT WRITE BELOW THIS LINE. s
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<br /> DTSC 8022A(1/99)
<br /> Blue. GENERATOR SENDS THIS COPY TO DTSC WITHIN 30 DAYS.
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<br /> EPA 8700-22 To. P.O. Box 400, Sacramento, CA 95812-0400
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