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State n(Calromfo--FleaMha11d1M�/a� y `� Deparitnent of Health SwAce
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<br /> Please P&t or type. FOlnl'diMiQred flpr w ofl ere 02.1. YpewrMe 1 SacfannMt/0,Carornk
<br /> UNIFORM HAZARDOUS1.Genet mar's 1b EPA O No, Manifest DocunentNo. 2 Pape 1` tnfonrsaibn in the%tended arse
<br /> WASTE MANIFEST I I 1 I I I I I I 11 01401136,1 1 of / Is not 1 qumdb'1'fe�"O�"'
<br /> 3.Generator%Name and Mailing address OW. IIIII111maJI(W
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<br /> 5.Transporter 1 Company Name 6.LIS EPA ID Number -,.,.
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<br /> 7.Transporter 2 Comparry Name 8,Ib EPA ID Number ;6ta�i►ll ......... "
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<br /> 9.Designated Focdty Name and Sde Address 10.(b EPA ID Number
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<br /> 16. CENE1tA70R3 CEnRCATton: I hereby declare that the conlenb o1 aNppha
<br /> d. *66«.Igninet��:tsar,► aacs.a qi d..ctb.d tat pager g nave and as classified.
<br /> O Packed marked.and labeled,and are in d respects in proper condtlon for transport by highway according to applicableIrMrsdbrsd and national goverment regulation
<br /> Q M I am a large quantity gener , certify that I cethat 1 have a Program in place to reduce the yand toxicity of wade•gwwtc ed to the degree I have deterrnk»d to to
<br /> Z economicaty practicableat and thI have selected the practicable rnethod of treatment,dorage,ordisposal currently avolable to me which minknires the present and future
<br /> rL threat to human health and the environmertt:OR.r I am a!nal quantity generator.)how mode a good faith effort to n**r*n my wade generation and select the best waste
<br /> marag0MW*method that Is mailable to me and that 1 can afford S i ,M,.
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<br /> Q Pnnted/lypecl%Jane c _ Sipnahre_, ,. i:d L f ;i it;:i: f aSllJf 2!�itacrTeu}.• _ MonM Lay Year
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<br /> N T 17.Transporter 1 Acknowledpennerrt of Receipt of Materials
<br /> 0 A Prnted/TypedNarr,e ,..`_i _ ,T+t'^2:3ctN;�•+SE•:-� -:t.f ..:.:�l:if� L?F 3•Ut1:^,15�• ''. '. HiG-ki;- MwsM `2t' '. Year
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<br /> C0 l S.Transporter 2 Acknowledgernent of Receipt of Materials -
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<br /> UF 19.Discrepancy rdicotion Space `
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<br /> I 2D.Facility Owner or Operator Certification d receipt of h®andora materials covered by this monofest except a<noted in Item 19.
<br /> T Frhtea/fyPed Moms - sigrwhre, q.3:%22/.. -. _-- MoWn Day Year
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<br /> DO NOT WRITE B LOW THIS UNE.
<br /> DM 8022A(12/90) Yellow: TSDF SENDS THIS :OF y TO GEENERATCR WITHIN 30 DAYS.
<br /> EPA 8700-22
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