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State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30.99) See Instructions Oft back O e 6. Department of Toxic Substances'Control <br /> Please print or type. form designed for use on elite(12-pits rites Sacramento,California <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> is not required by Federal law. <br /> WASTE MANIFEST $41 Al ri d 0101 A 515161713121 1 1 1of <br /> #ate Mgnrfes to nkf=tutn#tet `r <br /> 3. Generator's Name and Mailing Address <br /> GRANITE <br /> �tg�c yg� +��yg z�wg�1p� CO <br /> 47dSFY 1 1, .E CONSTRUCTION[\L��f 1 A V Bti tr a t'r ,std <br /> o { 9ggt�^?vv�9�tt S TRAYBLVDCA g T � ��� <br /> h tl. GAe`el�ator's Phone( ) , l <br /> f _ d 1 <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C rfae 1 fgttSffBTrs`f1Y <br /> v1 rr <br /> 0 :3- L A i✓ ICIA� L �'J}W <br /> fl TratsspQr#er s Pftotse f u� i ti�wa � <br /> 7. Transporter 2 Company N 8. US EPA ID Number F State lraasporter s7T? R #e edr} kf xe x� `� ""`t <br /> .- Name <br /> Q <br /> i�r x e wai <br /> U 9. Designated Facility Name and Site Address 10. US EPA ID Number Cr M#e F 1 Ify's f1} i'""i'A <br /> Z CHEMICAL VASTE MANAGEMENT, INC. <br /> re <br /> C-i ix <br /> 35251 OLD SKYLINE ROAD ' Phi <br /> �`_� IE� Ial4� � f" r 13 �.Y' � � 5 � <br /> 1 C1 A. "d � 0 6 � M17 , <br /> ~�-r 12. Containers 13?Total 14 Unit <br /> C4 V 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol pfif <br /> Z a. NON <br /> ggt ry�g p7(h �}g f.� 7;3 y.F q y ke <br /> _ w ON tr#� 11 .....A �.)" 4�Ac f�LI_fp �°m' � <br /> fb UR AS <br /> GM <br /> c\i E b. <br /> co E n <br /> R <br /> N ,r <br /> v A C. <br /> a <br /> T <br /> co O <br /> LU d. m <br /> Z m � <br /> wUj <br /> f" <br /> t� J Additiort-d pescrf s#ides far Mitler�f irstes Above 7f Ttar# hrlg Codec fa raslr€�s 1d#ed 71 tye i � 4 k <br /> Z <br /> 0 � � F <br /> W al 3 <br /> d hs � <br /> ce <br /> O 15 Special Handling Instructions and Additional Information <br /> CHENTREC Emergency Respon,-,�e Number (-8010)424-9300 VMT 'Contract <br /> Z <br /> W <br /> F-- <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accuratelyy described above by proper shipping name and are classified,pocked, <br /> Vmarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> J If I am a large quantiy generator,1 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 /> CL practicable and that 1 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 /> rn 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 /> ad available to me and that I can afford. <br /> OPrinted/Typed.Name SignatureMonth Day Year <br /> w T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> LU p Prints'Typed Name Sigt1'�jy_re Monttk Day Year <br /> LU , <br /> U_ B 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> T Printed/Typed Name Signature Month Day Year <br /> w E <br /> N R <br /> U 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> 1 <br /> L <br /> 1 20. FacilityOwner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> v <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) <br /> Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />