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OCT-27-2008 18!24 CITY OF LODI 209 333 6710 P.23
<br /> Farm Approved OMB No.2050-0039(Pxpirea 9-30-99) `4 acre ..°err r. uaponmanr o...;v, vw�um..4�•.•v�
<br /> Plaoso prim ar rype. Form designed kr use on elite(t2-ankh), iter, Socramen e,Callfamio
<br /> UNIFORM HAZARDOUS I enera US EPA ID No. ' ^ eaMst Doamenl Na. 2. shaded Page 1 Information in the am.,
<br /> G c C�7%^' '! +511OQ7f is nosrequired by Federm law.
<br /> WASTE MANIFEST aF
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<br /> 14. GENERATOR'S CERTIFICATION I here6y,derlore)hat the contents of lhis consiggnmenl are fullyand ocanop)rdmeribed above by praper shipying name a9d6:6 Blass ed,packed,
<br /> marked,and loboled,and are in all rNiceaa In proper eondi8on 6r transport by highway according ic oppl;,able international and'nalionaPgovernmenl regulations.
<br /> IF I am a large quanliy generalw,I carl:fy that t hove a pregmm In place to mdudn Ike velums and toxicity uF waste generated to Ike degree I have dwerminod Io be see6amleally
<br /> •d prerlllmoble and Blas hove selected the praetf<able method of rraatmenq storage,or dispwol aurran��I�o�ble to me which minimizes The present and future lhraal to human hpcd
<br /> h and d.o environment;OR, II I am a small quan8ry generator,I have made a good 6tlh ol(ort to ndnimrxe my wasp generation and salad Iha hest wasp management mathad tbal 4
<br /> Qam1oble to me and rhes 1,eyn tsf6 /':
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<br /> v_ 0 18. Tionsponer 2 Acknowledgemen,aF Racei t of Materials
<br /> 0 A Printed/Typed Name Signal.,* Manch Day Year
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<br /> V P 14. Ohenpanry Indication Space ,.
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<br /> 20. fe4iliPyCwnargrOporglarcodigcciian of rates 1 of hazardous mat.dals covered b This monifea.xce I a.noted In Item 19.
<br /> .T Printod/Typed Nome Signaluro Month Doy Year
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<br /> DO NOT WRITE BELOW THIS LINE.
<br /> DISC 5022A(1/99) Yc11ow: GENERATOR RETAINS
<br /> EPA 8700-22
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