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0 <br />F. Trani <br />at! <br />H 41F, <br />12. Containers <br />No. Type <br />I <br />Department of Health Services <br />Toxic Substistces Control Division <br />Sacramento, California <br />Information In the shaded areas <br />Is not required 4y Federal law. <br />WITH <br />Ki <br />13. Total 14. <br />Quantity I Unit <br />16. Special Handling Instructions and Ad itional Information <br />2 <br />J <br />Q <br />� 18. <br />GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br />and are classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and <br />national government regulations. <br />M If I am a large quantity generator, I certify that i have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined <br />0 to be economically practicable and that 1 have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the <br />present and future threat to human health and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste <br />generation and select the best waste management method that is available !g me and that I can afford. <br />ILIPrinted/Typed Name f r - 5 Signature Month Day V <br />WT 17. Transporter 1 Acknowledgement of Receipt of Materials <br />State of California—+lealth and Welfare Agency <br />Form AWroved OMB No,.2050--0039 (Expires 9- <br />" Please print or typn.. (Form designed for use on et 2 -pitch typewriter). <br />U. <br />�Y\ ®� <br />' UNIFORM HAZARDOUS <br />1. Generator's US EPAiD No. <br />Mar <br />® <br />UT <br />PrintedJT3ped Name <br />WASTE MANIFEST <br />1 <br />Z <br />3. Generators Name and Mailing Address r <br />19. Discrepancy indication Space <br />F <br />4. Generators Phone <br />A <br />8. Transporter 1 Company Name 6..^ US (}ESP\A ID Number <br />„ .. <br />�� <br />C <br />I <br />L <br />R� b✓ ,: f ice«... Y \. 6 i.md <br />, 1 <br />1 20. Facility Owner or Oper"Certificati3p of receipt of hazardous materials covered by this manife cept e8jumedin4tern 19. <br />T <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />®. <br />J <br />9 sig ted Facilityy Name and Site Address /0. US EPA ID Number <br />I�P•'Ca <br />[. <br />¢dam <br />�`ro' ` <br />t01„ <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />E <br />N <br />' (� s' l <br />eY <br />R <br />b <br />c°voe <br />T <br />0 <br />gh� <br />d' <br />U <br />W <br />N <br />e <br />0 <br />F. Trani <br />at! <br />H 41F, <br />12. Containers <br />No. Type <br />I <br />Department of Health Services <br />Toxic Substistces Control Division <br />Sacramento, California <br />Information In the shaded areas <br />Is not required 4y Federal law. <br />WITH <br />Ki <br />13. Total 14. <br />Quantity I Unit <br />16. Special Handling Instructions and Ad itional Information <br />2 <br />J <br />Q <br />� 18. <br />GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br />and are classified, packed, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and <br />national government regulations. <br />M If I am a large quantity generator, I certify that i have a program in place to reduce the volume and toxicity of waste generated to the degree 1 have determined <br />0 to be economically practicable and that 1 have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the <br />present and future threat to human health and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste <br />generation and select the best waste management method that is available !g me and that I can afford. <br />ILIPrinted/Typed Name f r - 5 Signature Month Day V <br />WT 17. Transporter 1 Acknowledgement of Receipt of Materials <br />DHS 6022 A 0 /88) Zbo Not Write Below This line Yelow: TSDF SEUR93M COPY <br />EPA 8700-22 Z .401 <br />(Rev. 9-88) Previous editions are obsolete. <br />DAYS <br />AN Printed/Typed Name- <br />SignatWg' - Month Day Year <br />U. <br />�Y\ ®� <br />P 18. Transporter 2 Acknowledgement of Receipt ofMaterialsW O ` <br />UT <br />PrintedJT3ped Name <br />Signature Month Day Year <br />E <br />Z <br />19. Discrepancy indication Space <br />F <br />A <br />C <br />I <br />L <br />1 20. Facility Owner or Oper"Certificati3p of receipt of hazardous materials covered by this manife cept e8jumedin4tern 19. <br />T <br />Print_900TYWMName_ /0001— Z_ <br />Signature Mph DaysY <br />DHS 6022 A 0 /88) Zbo Not Write Below This line Yelow: TSDF SEUR93M COPY <br />EPA 8700-22 Z .401 <br />(Rev. 9-88) Previous editions are obsolete. <br />DAYS <br />