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®Agency <br /> ..0.79(Expires 9-3 91) See If151fYC1iOf15 Oft back,. Department of Health Se <br /> rvice,•'^designed lo�'Ose on elite(12-pftch tyypewriter), \�°9e 6. Toxic Substances Control Program <br /> UNIFORM HAZARDOUS Sacramento.California <br /> 1.Gerseratoys US EPA ID No, Manifest Document No. 2.Pope 1 In/omnwbn kn the stotled seas <br /> WASTE MANIFEST 4 it I 1 I I� I or � e not required by Fadea low. <br /> KAN70ratoees <br /> NameandMdSngAddress s%liGP� Astate MwnfestOgcijrpentIWmg9t <br /> , /3 aPhohonrs�sFPL Iv: 9ys377 sss $ <br /> tie <br /> 5.Transporter 1 Company Name 6.US EPA ID Number C state tmauporfes s t[? /r�x. , <br /> 'f..•' TtGssp....rreys ...� <br /> 7.Transporter 2 Company Name B.IbE AIDNumber E SttrteT[aruolffJfY <br /> I I I I I I I I I I I F Trans eYs Phone <br /> .Deilgnated FocIRV Name and Site Addiess 10.US EPA ID Number 6 state Fdegtys O .: <br /> �0s���1"RR� �♦ 3<' <br /> '� .db�rrpsc w H :r Pharns <br /> 11.W DOT Description(Including Proper shipping Name,Hazard Class.and ID Number) 12.Containers 13,Told 14 Unit <br /> No. T QuantityWtNol E is ATumbet <br /> J a U.S. D2M-� ,UA�J/bpiC1�yd�100 E / irs 6!/AS%E L/llAEp <br />�zNKs <br />:)o E a store <br /> 10 <br /> R <br /> tRAZ <br />%ft T <br /> 0 <br /> R EPAlOttsBl --. <br /> .. <br /> .,yrs <br /> Sex. <br /> r <br /> N 2 <br /> J Pe....:. . ..fo7. Ahove K Naxs hg Cotlef for wmtes 18ted shove <br /> w f <br /> U 15 special Handfr q Instructbrn and A rtb of Information <br /> LU <br /> aj^3 70 1 <br /> W <br /> Z16. GENERATORS CERTIFICATION: I hereby declare that the contents of the consignment we fully and occdr&ety described above by proper shipping name and are clmsified. <br /> O pocked,naked,and labeled,and are in all r@ipecis In proper condition fav trwupod by highway according to applicable international and national govemment regulations. <br /> Qif I am a large quantity generator,I cerhf that I have a program In place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> Z economically practicable and that I have selected the practicable method or treatment,storage,or deposal currently available to me which minimizes the present and future <br /> w threat to human health and the environment;OR.If I wn a small quantity generator.I have mode a good faith effort to mirumRe ray waste generation and select the best waste <br /> management method that Is available to me and that I can afford. <br /> J <br /> Q <br /> Printed/Typed Name signature• Monm Day Year <br /> U <br /> a <br /> N T 17.Transporter 1 AckrovAedpernent of Receipt of Materials � <br /> 0 R Pitted/ryped Nene Signature Month Day Yea <br /> U N <br /> Z - f <br /> LU P rig .a r[�.//. - : .'!'.<r::✓!:•i ,,•'i%� r� ;s.,rt..r" Imo• I S I� I <br /> t&' 0 1&'Transporter 2 Ack ement of Receipt of Materials <br /> w R Prnted/ryped None Signature Month Day rear <br /> W T <br /> O E <br /> R I I I I I <br /> QF 19.Discrepancy Indication Space <br /> U A <br /> C <br /> I <br /> L <br /> 1 20.Foc*ty Owner or Operator Certification or receipt of hazardous materiae covered bythis manifest' anifest except as noted In Rem 19. <br /> T Pr:,rw/ryped dame signature Monts Dry year <br /> Y + _ <br /> -8- <br /> DO <br /> JDO NOT WRITE BELOW THIS LINE. <br /> DHS E022A(12M - Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> EPA$700-22 <br />