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. Zroved OMB No.2050-0039(Expires 9-30-99) 00 t' �9.See Instructions on back OYr ,Y <br /> Pleasesprint or type. Form designed for usa on elite j T2-pitch) iter. Department of Tpxic Substances Contr. <br /> Sacramento,California <br /> UNIFORM HAZARDOUS t -nerator's US EPA ID�No. r Manifest Document N,- 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST j /J f, is not required by Federal law. <br /> 4 (� 0 of. <br /> 3. Generator's Name and Mailing Address <br /> A. State Manifest Document Number <br /> �:�: ;rl��t . z �jr���I �� �_�. 23375509 <br /> tL` ' '�s%� B. State Generator's ID <br /> A. Generator's Phone (O +t +; c,} <br /> A! i.,lr--,.`0 1'',iD':ilo at!.i.3.i'vi-cpTi_t 1,t_-.,k S;`'-' <br /> LO 5. Transporter 1 Company Nome 6. US EPA ID Number <br /> C Slate Transporter':ID[Reserved.] <br /> CPO <br /> tt D. Transporters Phone <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved] <br /> J <br /> Q F. Transporter's Phone <br /> V 9. Designated Facility Name and Site Address 10. US EPA ID Number G. State Facility's ID <br /> ,zCu G z f 33 � <br /> 7i,:i?fi.�iC`.i?� <br /> - <br /> 10 H. Facility's Phone <br /> COIXIDWID 1a 90222 C ri IT 0 ' ! i > t-Y1';7?i?,7•-p'tts: <br /> J - t' <br /> Q I1. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number[ y 12. Containers 13, Total IA. Unit <br /> V P ( 9 P PP 9 <br /> Z a. No. Type Quantity Wt/Vol I. Waste Number <br /> _ Gasoline Um-Te State <br /> TTI1' Ct��'.t� ' <br /> 3 Gr ry T'r:, n EPA/Other <br /> oN b. ,,-•r n3 <br /> 0 E State <br /> C R EPA/Other <br /> C14 A C. <br /> o T <br /> Slate <br /> 00 0 , <br /> R EPA/Other <br /> LU d. <br /> Z Slate <br /> w <br /> V EPA/Other <br /> LU <br /> Z ,fF /Sifditional Descriptions for Materials Listed Above. K. Handling Codes For Wastes Listed Above <br /> o :ZrJC1{)i�l iiit1z llrz_i:r V. t afz F7 .f;!. I a' E�i )I 3T.711 Z Lei . 2 is a- O' b. <br /> Uf ' rxie LD.R.LU <br /> it <br /> i ri0i.r cylzired as o T>zzmey i t ci <br /> E:sc citation 251,79"u, C. d. <br /> 0 15. Special Handling Instructions and Additional Information <br /> FOLD LABEL AT DOTT <br /> Z rxsi]iint•?an�1 jr ilfer mixizzre. Vire appropriate pronact'ive ARCO 49-32 a j;`J# 70575 LINE. AFFIX TO RIG <br /> clil'i.hJ,.n..-. 16 li-4. t Hardsfl-I y' SIDE MATERIAL BILLS R T <br /> _ 6699••37005 C24 hour Emergency PhonejST0CNaTOI+T TAB STICKS OUT. <br /> LT196U 01997 Wut`l n <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,pocked, <br /> V marked,and labeled,and are 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 /> 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 <br /> and the environment;OR,if I am a small quantity generator,I have made a good Faith effort to ize my waste generation and select the best waste management method that is <br /> O available to me and that I can afford. <br /> >_ Printed/Typed Name Signature <br /> V Month Day Year <br /> LLJ <br /> T 17. Transporter 1 Acknowledgement of Recei t of Materi Is <br /> Uf R <br /> LU A Print am Signature <br /> N Mo- <br /> 74f <br /> Year <br /> LU S � 2 l v <br /> u_ 0 18. Transporter 2 Acknowled ement of Recei t of Materials <br /> 0T Printed/Typed Name Signature <br /> L E Month Day Year <br /> n R <br /> Q <br /> J 19. Discrepancy Indication Space <br /> z F <br /> A <br /> C <br /> I <br /> L <br /> 20. Facili Owner or Operator Certification of recei t of hazardous materials covered by this manifest except as noted in Item 19. <br /> YPrinted/Typed Name 1 Signature �jMonth yr�Day p�Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 8700-22 To: P.O. Box 3000, Sacramento, CA 95812 <br />