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<br />State of California—Env�onmental Protection Agency
<br />form Approved OMB No: 2050,-0039 (Expires 9.30-99) ', See Ins1TUc$i@
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<br />i 1. Generator's US EPA 1D No.
<br />!71F0 HAZARDOUS
<br />r WAST MANIFEST , ` ! '.71
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<br />^, A. Generator's' Phone
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<br />Sacramento, California
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<br />5., Transporter 1 Company Name 6. US EPA ID Number
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<br />Designated Facility Name and Site Address 10. US EPA ID Number
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<br />US DOT Description (including Proper Shipping Name, Hazard Class, and'ID Number)
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<br />15. Special Handling Instructions and Additional Information
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<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,
<br />and labeled, and are in all.respects in proper condition for transport by highway according to applicable international and national government regulations.
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<br />If I am a large quantity 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 />and that I have the treatment, disposal to and future health
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<br />practicable
<br />practicable selected practicable method of storage, or currently available me which minimizes the present threat to Human
<br />the OR, have faith
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<br />environment; if I am a small quantity generator, I made a good effort to minimize my waste generation and select the best waste management method that is
<br />available to me and that I can afford.
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<br />17. Transporter 1 Ac nowled ement of Rec i t of Materials
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<br />18. Tr sorter 2 Acknow) ement of.Recei t of Materials
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<br />20. Facility Owner or Operator Certification of receipt of hazardous materials covered- manifest except as narild-irrl 19. r
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<br />DTSC 8022A (1/99)
<br />EPA 8700-22
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<br />DO NOT ,WRITpF BELOW THIS LINE./ -
<br />f Yeliq TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS.
<br />_ __. ✓ (Generators who submit hazardous waste for transport out-of-state,
<br />produce completedcopy,of this copy and send to DTSC within 30 days.)
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