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itak of Califamlo-1.1ironmer" Prolactin Agency <br />;arm 'IAf .,.d OMB No. 2056-0039 (Epi. 93696) See Instructions on back of �e 6. DePaamem of Task Sabsnom, Coor.d <br />m prim or type: form desipmd !or . on Biro J12pikb) t qer S.",ureaso, Caltformo <br />I <br />DO NOT WRITE BELOW THIS UNE. <br />TSC R022A (1193) Yellow- GENERATOR RETAINS <br />PA 8700-22 <br />UNIFORM HAZARDOUS 1. C'enerames US EPA ID No. <br />Mmdfes Doamm�t No. 2. Page 1 nformation in the haded meas -� <br />. <br />r <br />WASTE MANIFEST <br />^ +b Is not ra9oired by kderal law. <br />y <br />3. Generator's Name and Mailing Address <br />' <br />w5`mttsr�r r, A <br />I <br />A. Generon is Phos (,sq. <br />5. Trossgswtarompany Name , 1 C 6. 11S EPA ID Number <br />r <br />%-tCoq]46 <br />! <br />I <br />7. Transporter 2 CoApany Name S. US EPA ID Number <br />9. DesigV �Miry Nomid Sine Address 10. US EPA ID Number <br />ysr N <br />I <br />11. US DOT DescriptionDescription('mdudirp Proper Shipping Name, Hozmd Class, and ID Number) <br />t2. contnnurs - " <br />13. Total 14. IAdf <br />No. T VH/Vol <br />Q <br />_•Y':roslw `f.rsTcb. <br />T` <br />f? <br />E <br />N <br />b. <br />E <br />R <br />A <br />T <br />C. <br />O <br />R <br />d. <br />15. Spedd HmdRng ke nuallonv and Addniortd IaformsMion <br />Vetj xvav f E F*o :nL11 — ? s <4 } rU t ' <.�['t Al Yet?,t'r-+hzlo <br />hay, 1141 1 -4lf"n i.xs9 k irul itrok#y') <br />s�9 <br />+q `/ .�[ <br />16. ODMATOR'S CBMIFICATION! I hereby de,k re that the comonh of this consignment are fully and accurately described above by proper shipping none and aro clasaflied, <br />Railed, marked, and labeled, and am in all respxts in proper condition for transport by highway accort irp In applicable inuumniss d and nallonsssh goY pmerse t reguhniom- <br />If I am o large quantity generator, I terrify Mot I have a program in pix. to redoes the <br />volume and taalcity of wasR gemnared to the degree I have drowromwd to be <br />ecommukolly woetkable and Mas I hove selected the practicable method of troatmem, m <br />, or d eposd currently available to me whkh minimizes the primeof and Induce <br />threat M human health and the em ironmem; OR, if 1 am a smolt ge�,rabr, 1 ha <br />ado a good faith effort b mkiimmize my w®b geraration and select this boss <br />waste mono em method thW a aaodoble b me aril Mot f can for r^ <br />PrI te! jpod Nmne <br />_ <br />ese <br />1 <br />R <br />17. T 1 Acle d Room. of Masxiak <br />P <br />�� N. ypd No. <br />'M1 a ' <br />° <br />! <br />6 <br />IS. Temisperferr 2 Acknomisdowment of R of Materials <br />1 <br />Pnmed/Typed Name <br />Mortis Day Your <br />E <br />R <br />— <br />19. Dncraponry Indicafian Space <br />F <br />A <br />C <br />1 <br />1 <br />20. Fodey Owmr or Ocervesur Cerrihcation of receipt of hazardous materials covered by this manifest esseptos rated k Rem 14. -� <br />YPrlmed/TYped <br />Name Slgnomm, <br />Moseh Day Year <br />DO NOT WRITE BELOW THIS UNE. <br />TSC R022A (1193) Yellow- GENERATOR RETAINS <br />PA 8700-22 <br />