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State of California—Environmentol Protection Agency E <br /> Form Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on back o@ 6. Department of Toxic Substances'Control <br /> Please print or type. Form designed for use on elite f 12-pitch iter. 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 C1 Al Cl0 101 2 y 9 <br /> 7131 of <br /> 3. Generator's Name and Mailing Address f#ate—Ali ifest4oewment NGRANITE C'ONSTRUCTION CO <br /> umb h1 ` . <br /> ( O) a fl StategelafCrSfftd ? ! Gis BLVD <br /> kn $A 95376 <br /> LO . 6 "eatoi3_3 s Phone <br /> f , <br /> N 5. Transporter 1 Company Name 6. US EPA ID NumbertateTranspartet"s <br /> LO <br /> let,ars hen' <br /> r t <br /> x <br /> 7. Transporter 2 Company Name 8. US EPA ID Number ' Stafp l4#00',0454D R ecus` ) <br /> F Transap�ttT s Rhone `. <br /> V 9.��TppDessyiiggyynatedppFaci�litty Name andSiteAgdBdrresssq p INC,, 10. US EPA ID Number Stmt&F tly' I17 <br /> Q ��ttEt"St.CAL WASTE S"ANAGS:�t-1 �tt�r 1 Nit - <br /> w :;52 5 I Oil slyy{'�y��A r»i..I R ROAD It Raoihty s#hand pp��. � ��a <br /> 0 "TTLAlS�RCrCA 932. - l .f ? Lf 4a 11 117 <br /> WE <br /> � . <br /> Q12. Containers 13. Total 14 Unit <br /> U 1 l. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol 1:; W gstq Nutrif3eTk f <br /> Star <br /> Z a. {ey n h lj�jgdj 0/Y� 'r W A gI+-,yT fI;p d 1{I�f <br /> 1--- ( .A,C 9 U� 1A fL 377E..'s6Lt.e, —L>$[ 7 <br /> O N b. <br /> L tl da I'i f <br /> OD <br /> S ilp� d�.4�W�rkrwM ft+a ai 1 -Ii <br /> co00 <br /> - aiti a �� k1 ast✓yl C 7r ,r�. <br /> wd. 1a# ,,Fgk <br /> U-1 <br /> ZI. Ad clltionaFDescrdpt crii far Mgted-416 A{aave f liatadf�n Cac(a�for Yyastes UstedAfisovtb ,. <br /> s #'. x m'�''i 'r �� a, r$ i,t W+ rt 9 Y w �b,�1 rte•- '.� <br /> mow. , <br /> W <br /> 0::. tV own <br /> Z 15. Special Handling Instructions and Additional Information <br /> Q CCE TREC Emergency Response Nv111be (80011424-9300 V'N 'CONti-act. <br /> Z <br /> W <br /> t- <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment ore fully and accurately described above by proper shipping name and are classified,packed, <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 /> If I am a large quontiy 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 /> CL 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 /> In 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 /> W available to me and that I can afford. <br /> O <br /> } Printed/Typed Name Signature Month Day Year <br /> Z KPI <br /> 1 r _ l <br /> W TR 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> w S yp Name Sfg�ature nth Day Year <br /> A / <br /> Pn to T ed <br /> R <br /> w � t t ' ,4 ��.t- TMO; <br /> W B 18. Trans orter 2 Acknowled ement of Receipt of Materials <br /> RPrinted/Typed Name Signature Month Day Year <br /> T <br /> W E <br /> h R <br /> Q <br /> V IF 19. Discrepancy Indication Space <br /> Z A <br /> C <br /> 1 <br /> L <br /> f 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> j Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) <br /> EPA 8700-22 Yellow: GENERATOR RETAINS <br />