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-- x- <br /> State Of CQlifOmiO---E"1i'Onm6f*OI Protection AVenc, <br /> 5acromento, California <br /> (34�nerator's US EPA ID NoManifest Document No, 2Page I <br /> UNIFORM HAZARDOUS� Information in the shaded oreas <br /> ASTE MANIFEST <br /> 3. Gc7fGtOr'�Name 911d.0ailing Address <br /> T. <br /> 5. Transporter I Company Name <br /> 6. US EPA 10 Number <br /> < 7. Transporter 2 Company Name 8. US EPA ID Number <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Numb*, 1111!1�W— k <br /> yj <br /> 1324 <br /> 12 <br /> 11. US DOT Description(induding Proper Shipping Name, Hazard Cl�,and ID Number Co ainers 13, Total IA. Unit <br /> a. <br /> EPA <br /> Z I rm, <br /> 15. Special Handling Instructions and Additional Information <br /> JJ <br /> I& GENERATOR'S aRTIFICATION- I hereby declare that the contents of this consignenent are fully and accurately described above by proper shipping name and are classified, <br /> < packed,marked,and labeled,and are in all respech in proper condition for transport by highway according to applicable international and national go�emmeni regulations. <br /> If I am a large quantity generator, I certify that I how a program in place to reduce the volume and toxicity of waste generated to the degree I hcrve determined to be <br /> economically practicable 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, 9 1 am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> waste rnanogernent method that is available to me and that I can afford. <br /> Printed/Typed Name Signature Month Day Year, <br /> Month Day Year <br /> A Printedayped Name Si <br /> .0 0 18. Transpo;er 2 AckrPowledgement of Receipt of Materials <br /> I Month Day Year <br /> T Printed/Typed Nome <br /> Ij <br /> 19, Discrepancy Indication Space <br /> Z C- <br /> 20. Focili Owner or Operator Certification of receipt of hazardous marterials coyered by this manifest except as noted in item 19. <br /> ly <br /> Ape <br /> DO NOT WRITE BELOW THIS LINE. <br /> ="' "== "/95) <br /> EPA 9700-22 <br />