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Department of Health ServlCea <br /> Te,IG SlibatenCee Coairol Division <br /> sista yyI C6Sllo4nla-1'taelth and Vlellere ApencY q r <br /> Sacramento,Celllornle <br />'• FarrE!Appraved OMD No.2056-0039(Expires 9.30611 typewriter) de <br /> Mnnllaat 2.Pape I' inlorMatlon In the shaded■rags <br /> plogyp print of type. (Form designed for use an afiEe j�(Q narralo'a US EPA I o• Document Na. is nal fequlrad by Fedaral l+w• <br /> 4�N <br /> WASTE MANIFEST <br /> of <br /> 3,"Ognerator'e Nemo cnd Malting AddreeaIVA <br /> • +. to "e g us EPA ID Number <br /> SQ 5,Traneportar 1 Company N+mp <br /> t• <br /> a _ n a <br /> r Y <br /> til. v�€PA to K4�1lf-�(.'. � h S�' ,�::�s rr S y <br /> r 4:paelpnatad Fecillty Name and Slq Address <br /> OF �4q®� q` <br /> = J <br /> CWFM <br /> 2.Co Finan �� l �'��`, a10 1'o.[t r••� t <br /> Quantity Unito <br /> po, Type WlrVl <br /> i.US DOT Dosed lion(Including PNPer Shippin0 Har Hazard Gaeta,and 10 Number) SIa1q <br /> � � Y � ' 00 DT00 Z Y RPAr <br /> E <br /> N i �pArOlh}r"' <br /> .T b Il Plata + <br /> d. <br /> Lu <br /> vrai "A PQ$ PSISM iP.l. 414FIl�}k14110 PRY* <br /> a <br /> V. <br /> FOX, <br /> . 't �'1 �.1:��.1F i 1 -' t d�i:. F 1��Fir sail nu L sl't>'e•-,..r .1 i .. <br /> Q <br /> F ItS.6pecial HandBng Instructions and Addilionel Information , <br /> PS& ibed above by <br /> iTCl ill d WALS AW PRO i <br /> - 19 and accurately da2c, ding to applicable Interer national aatl <br /> U proper o highway <br /> GENERATOR'S CERTIFICA IO kedI and by dedl end arelIn®all respects In <br /> this <br /> oper condition for lrenep rt by g <br /> and ar,classified,p degree I have determined <br /> p, nations]pcvefrmant repulatlone. a my waste <br /> or disposal currently available to me wh!ch minimizes the <br /> I!I am a large quantity generalar.t certify that I have a proarr.m In pisco to reduce the volume and to,Orly rat os waste ganereled to the <br /> to bee large qua Precdcable and that I have■elected the practicable method of treatment.Gone for. P <br /> to <br /> present and tufa ll thrust to human health and fhe environmr.nl;OSt,II k em a small quantity geneto rntor.I have made s wood faith effort to minim enlh Dey Yeer <br /> U <br /> generation and select the boot waste management method that is available to me and that I can elfoid. <br /> Signature <...:�- <br /> ttuu printed/Typed name <br /> C7 <br /> fMonfh/Pay �v gr <br /> T 17.Transporter t Acknowledgement of Racelpt of Malerleta Signal a <br /> RodNama <br /> A <br /> print jofT P <br /> 0 g Z •�: Monln Pay Year <br /> P 18.Transporter 2 ACknowlad9amenl of FlacetPl of Matarlala <br /> W O r Signatule <br /> ` R PrinlediTyped Name <br /> V T <br /> E <br /> Z <br /> to,Discrepancy indication Space <br /> F <br /> A <br /> C <br /> 1 <br /> Monftv Day Year <br /> 20.Feelllty Owner or Operator Cortltkallnn al receipt of harardom msteri gignature d by this mendeal except ee naiad In tem <br /> rintediiyped Name <br /> L <br /> =Dc; 01 (jrs <br /> 122 <br /> PNS 8x22 A(t f88) <br /> EPA e7oo-22 YELLOWt GENERATOR RETAINS <br /> {Rev.g.e8)Previous editions ars ob601ota. <br />