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Jrote of lOLtomro--cnw,rorunerya�ProteCfion A <br /> �roved OMB gency <br /> P1.es. too.20W-'0139 fExpirn 9.30.96) See Instructions on back of <br /> or type, fb"r b"rb!!W for u"on OEM 172•pdEh/h•pewrirer. page 6. <br /> fkpartment of Tonic Substances Comro <br /> UNIFORM HAZARDOUS I- C-MMfa1ae s U5 EPA Ip No. f• Sacramento,Califomia <br /> WASTE MANIFEST Manifest Document 2. Page 1 Information in the sha <br /> 3. Generator's Name and Moiling Address dra areas <br /> rs no+required by Federal law, <br /> q A of <br /> til Kra �r1 11 <br /> toCP Sn/ <br /> 5. Tr <br /> o . <br /> O <br /> Q7, Transporter <br /> (J 9. US PA ID Number I r "' f" ' <br /> Z 9. Designated Facility Name and Site Address P•T i n �( a <br /> � <br /> Ear.icke-ClL1,ti1C, 10. US EPA ID Number ��� s 4', <br /> O <br /> 2 5 S Purr �1vcl. i �t�+ ;•, <br /> Ff. 1J5 DOT Description <br /> Z P (including Proper Shipping Name,Hazard Class,and ID Number ` 13. Total <br /> 14 Unit <br /> _ ) 12. Containers <br /> N,'-- '1-PC-,r, Heizardous Waste ; 1, Quantity Wt/Vol I..Wade Ah�ir y <br /> 3 �1�_ e ol. _ <br /> c' �,y� <br /> O E WcY_ifiF Er�?tv 'St.Orage Tank- .. -.:• .�.`J,:R .a <br /> MM N b. a' '1,1 Pr EPA , <br /> R <br /> C. <br /> '? R . <br /> JJ <br /> Z d. I EPlAj/dilier <br /> .^..3^ <br /> Z 1 >PA'/I31lser � <br /> Y <br /> 15. Special Handling Instructions and Additional Information F <br /> L Key--p away fI dli �n UrCP� O Z Yt I;tt. <br /> _ 9n Always r rare-.k.iat z.,{:en w: k <br /> U.G1 2A H:L- CC4 tt&-t 4,. <br /> .� . � i+kutlle- L ;v�7ir 7�'!._�F' F'�t•�t <br /> 16- GENERATOR'S CERTIFICATION: I hereby d«lame that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, <br /> pocked,marked,and€abeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> If I am a large quomity generator, 1 certify that I have o program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically an health and that I have selected the Practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> � threat to human health and the environment; OR, it 1 am o small quantity <br /> waste man ment method that is available to me and that I can afford. generator, I have made a good faith effort to minimize my waste generation and select the best <br /> Printed/Typed Name Signotsr'o <br /> i� y Month Day Year <br /> T 17. Trans rter 1 Ac wlad ement of Recei t of Materials <br /> R <br /> A Printed T d Na Sig re <br /> k <br /> Month pay Year <br /> P i s <br /> 9 1 rens rter 2 Ack -ledgeme-nT of Recei t of X <br /> T, Printed/Typed Name <br /> Signature Month Day Year <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> 20. Focil- Owner or rotor Certification of recei of hazardous materials covered by this manifest except as noted in Item 19. <br /> T ed/Typed Nome <br /> y Signature <br /> Mon�t�h/} Day Year <br /> DO NOT WRITE BELOW THIS LINE. <br /> s Yellow, TSDE SENDS THIS COPY TO GENERATOR WITHIN 30 DarS <br /> ,C 8022A (1/95) (Generators who submit hazardous waste for transport ovt-af-state, <br /> ` <br /> 8700--22 produce completed copy of this copy and send fo DISC wdt ;n 30 days ! (t <br /> i <br />