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• <br /> f <br /> ,,r type. (Form designed for use on e--t12-pitch)typewriter.) Form Approved.OMB No 2000-0404 Expires 7-31-86 <br /> 14IFORM HAZARDOUS 21.Generator's US EPA ID No. Manifest Document No. 22. Page Information in the shaded <br /> `WASTE MANIFEST C A D 9 8 1 1 7 0 3 4 3 6 0 7 0 1 areas is not required by Federal <br /> (Continuation Sheet) law. <br /> 23.Generator,V* Printed Circuit Board c/o N. Sarnevesht L.State Manifest Docu ber <br /> 27�900�2.1S. MacArthur 8 5 0 2 4 <br /> Tracy, CA 95376 M.State Generator's ID <br /> 24.Transporter Company Name 25. US EPA ID Number N.State Transporter's ID <br /> Z4r,- tf45-- AS`T—LC,- 17411Cj ZQ'1Aj O.Transporter's Pho <br /> j 26.Transporter Company Name 27.US EPA ID Number P.State TransporteestD <br /> Q.Transporter's Phone <br /> 29.Containers 30. 31. R. <br /> 28. US DOT Description(Including Proper Shipping Name, Hazard Class,and ID Number) Total Unit 4Waste No. <br /> HM No. Type Quantity Wt/Vol <br /> a. <br /> Co Q RQ51 U E l_ to�D U •A- l 7 /rj' ti <br /> b. wk�sTE ;a,e�D c-�G Ip W0 U U-I-I�0 <br /> >e COP-ROSI(.>E f. � ' vIl� <br /> c. w ASS-re A,-,,C° I,D L L) I R t a6S <br /> CG RQOS/U� iDRUL-k '76 <br /> { <br /> �` ^ ^^ <br /> E d �tjEST6 E C + vU IL 1.) GS UI.1 —I-X, O 4IN <br /> ' <br /> E X eaCVZ0SIU6 X46-rr-- 4Z 10 oLA, �s ° 1 ► G 1l1 <br /> A e. l V , E 4 L.tc L► LX- L-I U f,D I., GS <br /> R 0Rum � <br /> U 6-rRIpL tuA-1.719 <br /> f b5 T t I (,U t <br /> C°_OrLVLUS�V A-r-tip-1AL, <br /> Rum tC) { 3O I <br /> 9 �����/ �t � Q (V1� � ;. V !J-i � rid <br /> n. LUAST ,0 1� L t q 1 D u dS v,u-�/'? <br /> d Q P-Q C61 U6 P Asrc-�R� Q <br /> QULt 11. <br /> i. w 0 STE 6(S I L 19 U 1 40 IJBS Ut�) -17 <br /> >< CD ORrJ u i 0-)E � (1(4 ( Z.C- SS � V III <br /> S.Additional Descriptions for Materials Listed.Above T.H dling Codes for Wastes Listed Above <br /> C,=W CZ/ 8� ' iR +.p <br /> LUalso 0.k e- (2,I o I o c a lao56 w ITw amtZ <br /> 1? <br /> I.to 6's( al( , R E Ak �U iu k tlV,,D�r� <br /> 32.S cial Handling <br /> HIanJdGlin CSIISOstRrucItCionrs andC�Adt d�ijtion�al GInfo�rtion <br /> 1-1 �'Ctq4OR+C AcItl IzW <br /> l-rk/ Cu�,it lZ i o,uS <br /> T 33. Tr sporter Acknowledgement of Receipt of Materi Date <br /> A Printed/Typed Name Sigroture Vonth Day Yea <br /> N <br /> s O <br /> P <br /> o 34. Transporter Acknowledgement of Receipt of Materials Date <br /> T Printed/Typed Name SiCfiature Month Day Year <br /> E <br /> R <br /> i A 35, Discrepancy Indication Space <br /> c <br /> I <br /> , <br /> T <br /> y <br /> Style F16-6 Labelmaster,Chicago,IL 60646 EPA Form 8700-22A(3-84) <br />