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imia—Environmew9ki'mtection A9, <br /> rod OMB NZ4T�44X)aV(Expires See Instructions on back of <br /> 7n--!type, $jgn�for use:.on elite(1,_ 4 Substances Control <br /> Sacramento,California <br /> [PA ID No.. Almnifest DcunnerVN.. I h4yn c shaded a4as <br /> ml,i= <br /> UNIPORWHAtAiio' age <br /> I y Feid <br /> WASTE MANIFEV, A idw. <br /> E'v'N,Pill L. <br /> A'tEey vvvit -3 <br /> 606 ZO <br /> 3. Generator's Name and Moiling Address <br /> JUL TM-1 <br /> St <br /> C10 4. Generator's Phone <br /> 0 <br /> 6 5. Transporter) Company Norind—Z 6. US EPA ID Nvmber' <br /> C) <br /> Transporter 2 ompany Nome <br /> S. US EPA ID Number <br /> K. <br /> 9. Designated Facility Name and Site Address 70. US EPA ID Number <br /> W1 <br /> �p T <br /> LL <br /> 4,1V <br /> ,1 12. Containers 13. Total 14. Unit <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and 11)'Number) <br /> r NoType Quantity Wt/Vol <br /> 1*. eel <br /> G <br /> E <br /> N b. <br /> co E <br /> R <br /> A <br /> o T <br /> C9 <br /> R d. <br /> ON <br /> -AV= <br /> U <br /> 15. Special Handling Instructions and Additional Information ez'vlw�'4- <br /> e;ee42 <br /> F7 gk i <br /> 16, GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, <br /> packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> It I am a large quantity generator, I certify 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 /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which hnihinnii7s the present and future <br /> threat to human health and the environment, OR,0 1 am a small quantity geStarate cle aith eff rt to minimize my waste gener6tion and select the best <br /> waste management method that isovailable to me and that I can offord;--- <br /> Printed/ <br /> Typed Name,4,`. Signature M is Day Year <br /> a a zIc- <br /> 17. Transp2rter I Acknowlecigement of Recei2t of Mai Is <br /> Printed/Typed Name <br /> Signofd Month D Year <br /> 57A4/77/ <br /> Lu F I ( <br /> :E 0 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> LLJ <br /> ir /Typed Name Signature Month Day Year <br /> E <br /> jL 19, Discrepancy Indication Space <br /> V) <br /> < F <br /> SJ A <br /> C <br /> I <br /> L <br /> 1 20. Focili Owner or Operator Certification of receipt of hazardous flAa Is covered by this manifest except as noted in Item 19. <br /> T Printed/Typed Name ign re f Month Day Year <br /> y <br /> IJO <br /> IT WRI E BELOW TFIIS LINE. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAM <br /> ,bTSC 8022A '(9/93) (Generators who submit hazardous waste for transport out-of-state, <br /> iiPA 87.DCI---22 produce completed copy of this copy and send to DTSC within 30 clays.) <br />