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� p , <br /> State of California—Environmental Protection Agency <br /> Form Approved OMB No.2050-0039(Expires 9-30.99) a ee Instructions on back a 6. Department of Toxic Substances"Control <br /> Please print or type. Form designed for use on elite(12-pif rifer. 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 Q1 Al CI 01012151516171 ,3121of I <br /> 3. Generator's Name and Mailing Address 5tate,tvlottlfesl f�4Cunteat l tuto�rer � ��r �vd; <br /> GRANITE CONSTRUCTION CO I �� <br /> li <br /> O30909 5 TRACY EILVD 8 State Cipaerator s fD i �W���y�� p�s <br /> nA 95376 <br /> W) W'islator's Phone( 2og) _ <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number $fate irbrrspadie <br /> tq ,qi <br /> V•7 <br /> o P r q �p p Trartpdrter s Fhap& �� i <br /> 7. Transporter 2 Company Name Yt 8. US EPA ID Number $tate 7retnsporfer s.112 ese ed z' € <br /> CO-10 <br /> . ,- 77r, <br /> � F Trottsp�rter's Phoge # „� s `1, �r$ gx <br /> V 9. Designated Facility Name and Site Address 10. US EPA ID Number Cg State Faeshty s lfl <br /> ak i � <br /> — <br /> CHEMICAL r��WASTE MANAGEMENT, INC. <br /> _` zz 3�K5I OLD SKYLINE ROAD � )acstttysPhone �t R <br /> KETTLE AN CITY CA 93239 1 ClTj 010101614161 1 1 11 7,,,'': <br /> —' 12. Containers 13. Total 14 Unit <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol ^'C ate #tmF#ep , <br /> Z 11pq,ayA.r f�f@D�^p�y��{pp}eydS,iS"y]�) �qp x }�<C[11e/ @` ,°/`A y��.0{", f,t a gtj6te k Mail: ," <br /> t= Yt..BA1„IA. A0..a f.J ulai &� 6.}OP/ 1..)8 J61 R.4SJ <br /> 3 G o O �Plcra `A <br /> N E b. ',tate �h, �G� %I . <br /> 0OD 7– <br /> O E <br /> f frt et 1 m <br /> CN <br /> A C. <br /> 0 1 - <br /> ao <br /> R <br /> w d. tate t , <br /> w <br /> b <br /> N J Addit,cnc)Desnpttrrls for Moteripls L,sret above t' K NonsFtrig Codes foWates Ltsted:lkltts I” * F <br /> Z <br /> Q 6 <br /> ��yyyy '17 <br /> d:s# '1 <br /> t a. - 1 u ti t '✓'< . <br /> w <br /> � w <br /> � .1 C �d: iii t :i hd� ttlykia� <br /> r <br /> 15. Special Handling Instructions and Additional Information <br /> o C.HEMTREC Eater-genoy Response Number, 14.004"24-'93100, VIII r'on't•vact <br /> Z <br /> LU <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, <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 quantiy 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 economical)y <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 minimize my waste generation and select the best waste management method that is <br /> °c available to me and that I can afford. <br /> O <br /> >_ Printed/Typed Name r Signature Month Day Year <br /> Z A" <br /> w H 17. Transporter 1 Ac nowlecl ement of Receipt of Materials <br /> CX <br /> A Printed/Typed Name i Signature Month Day Year <br /> LU <br /> LA_ 0 1 . Trans orter 2 Acknowled ement of Recei t of Materials <br /> TPrinted/Typed Name Signature Month Day Year <br /> w E <br /> N R <br /> Q <br /> U 19. Discrepancy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner 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 /> Y <br /> DO NOT WRITE BELOW THIS LINE. ' <br /> DISC 8022A(1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />