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State of California �nnrarigi T - <br /> Form Approved OM8 Na 20 p <br /> Please print or type. forgr _J coons on back opeefi66. 95 <br /> epa <br /> tS3gr fes:. Drtment of Toxic Substances Conn <br /> s 5ouamento,California <br /> ' UN}�` Manilest T3ocumenf No, 2_ Page T Information in the shaded Drees <br /> i © ; is not required by Federal law. <br /> 3 Genr4 A Sfafa'Monifest a ? <br /> {�dGltrtiErsl ' <br /> � t <br /> tit B. State Generatdi"s ID <br /> C, State Tran }r r <br /> spatter's 1D[Ruse � '� >✓ , <br /> E- .� � 7 9 9 6 Trpnspcxtor's Phone ( +G� �.r'-�' Y, <br /> co <br /> 7. Tranfp$lcr 1��( � Stote[ranspoeter's ID(Reserved.) <br /> V f. Trao"'rFeis Phone <br /> Q 9. Dias . &isl G,.Slute Fuc+hty's <br /> $ 4 L to <br /> 0fl. Faili 's Phone <br /> o7 r +CK &11�51 n _ <br /> 416151 <br /> - (415) 324-1 <br /> Ly 11 U$D611_E scrtplran du 14.Proper ShippRng 1 aigi� yy��� 1 AAii'''''__ 12. Containers 13. Total lA. Unit y <br /> arm ?Ss *s}yi+a'3 Y <br /> za '- -�,--� v' ' _ Na. Ty Quantity .Y✓t/Yol ,1 Waste Number <br /> IG <br /> C4 tj 6 T G <br /> CIA <br /> her <br /> 0000 E <br /> 1 } <br /> v <br /> c. <br /> o T <br /> co O <br /> � r?tli€,t <br /> 4 <br /> s1J <br /> flartrfFi V Codes tot W{[3fes listed Ahrne' 3 <br /> h <br /> 15 S_..- <br /> � pedal Handling lnsirucfions and Additional <br /> Qawow wpm plLt tom) w� <br /> 16. GENERATOR'S CERTIFICATION: 1hereby-declare IflaF the�onfentx of tl£s cdrsst rtment OrC fully and Decor described above b proper xfii in .name and are classified, <br /> marked,and labeled,and are in all respects to pid�p cartel Bost fat Iron � hi h y p Pe pr 9 packed, <br /> sport ksy g way occording to applicable international and nationa government regulations. <br /> If I am a large quantity generator I cerfify that I fare a as <br /> a proctica6le and that f bore selected else: ca6hs " t4 ypdU�e the volume and toxicity of woste generated to the degree I have determined to be economicuNyy <br /> and the _ �q � ar'dispasa!currently available to me which minimizes the present and future threat to human health <br /> avail ble to me andtdh f I can afford a - g el "Ji-rt minimize my waste generation and select the best waste marwgcment method that is <br /> Printed/ 7 <br /> WQ^ �y. ��I�f,/r �. Month }flay Year <br /> T17, Trans 1 Acknowl emenl of Reoei <br /> R <br /> yt A Prin ed NV. <br /> R <br /> LU S /f /_ Aon Day Year <br /> P / w l !3 G <br /> � 0 18. Transporter 2 2 Aeknowfed emeni of Race' of A7laferxc>js <br /> T Printed/Typed Name Si <br /> gn Ware <br /> E <br /> R - Month Day Year <br /> 14. Discrepancy Indication Space '-- - <br /> z IF <br /> A <br /> L <br /> l 20. Facili ,Owner or_ rotor Certification of race of E<ozardosts mcd trait vexed fa }his manilesf exc i as noted in Item 19. <br /> T Printed/Typed Name <br /> ' Y Month Da Year <br /> 3 a a <br /> DO NOT A►Rt •'RLOW THIS LINE. <br /> �DTSC 8022A it/991 White: TSDF SENDS THIS COPY T DT <br /> SC DSC WITHIN 30 DAYS. <br /> EPA 8700-22 <br /> To P.O_ Boa 3000, Souamenla, CA 95812 <br />