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----- — ---- — ---------- ------------ <br />Protec3ion Agency 07 <br />_=;��=nvironrnental <br />0-01 See Instructio age 6. <br />No. 205O -W39 (Expires 9-30-94) - 1615 ns on back* <br />Please print or type. Form designed for use on elite (12 -pitch) typewrite, <br />Z <br />UNIFORM HAZARDOUS <br />1. Generator's US EPA ID No. Manifest Document No. <br />0 <br />= <br />N <br />S <br />WASTE MANIFEST <br />C 1, D t. IT, <br />Uj <br />P <br />3. Generator's Name and Mailing Address <br />.;5 ".IC.? , F. <br />0 <br />0 <br />T -1 'Zff'J T <br />R <br />T <br />Printed/Typed Name <br />Signature <br />U_ <br />0 <br />C14 <br />CA 9..?424 0 <br />2 Uerator's <br />U1.1 <br />19. Discrepancy Indication Space <br />Phone, <br />F <br />00 <br />6 <br />U <br />5. Transporter I Company Name 6. US EPA ID Number <br />C <br />I I <br />1 <br />U <br />Z <br />covered by this manifest except as noted in Ite <br />Printed/Typed Name <br />7. Transporter 2 Company Name 8. US EPA ID Number <br />Department of Toxic Substances Control <br />Sacramento, California <br />2. Page I Information in the shaded areas <br />is not required by Federal law.. <br />Of <br />13. Total 14. Unit <br />Quantity Wt/Vol <br />LU <br />585 B- D <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br />P marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable federal, state and international laws. <br />U <br />If 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 minimizes the present and future <br />threat to human health and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br />waste management method that is available to me and that I can afford. <br />0 Printed/Typed Name Si nature Month Day Year <br />U <br />V <br />Q� <br />Z <br />T <br />'I-7,."Tr iher"I-Ackn,3;�viediiei;Ze-ntotRe-c t of Materials <br />0 <br />= <br />N <br />S <br />Printed/Typed Name <br />Signature <br />Uj <br />P <br />0 <br />18. Trans Srf-6r Acknowled ement ofke—&iet of Materials <br />R <br />T <br />Printed/Typed Name <br />Signature <br />U_ <br />0 <br />: <br />I <br />U1.1 <br />19. Discrepancy Indication Space <br />0 <br />< <br />F <br />U <br />A <br />C <br />I I <br />1 <br />U <br />Z <br />covered by this manifest except as noted in Ite <br />Printed/Typed Name <br />Signature <br />T <br />Y <br />0 <br />00 <br />OP <br />14 <br />C4 <br />6 <br />0 <br />C? <br />LU <br />Z <br />Uj <br />U <br />Uj <br />0 <br />Z <br />0 <br />0- <br />tt) <br />Uj <br />Z. <br />. ..... <br />0 <br />15. Special Handling Instructions and Additional Information 9-147 61.64,f <br />383342:2 <br />f. 44,60 24"i"R <br />Z <br />Department of Toxic Substances Control <br />Sacramento, California <br />2. Page I Information in the shaded areas <br />is not required by Federal law.. <br />Of <br />13. Total 14. Unit <br />Quantity Wt/Vol <br />LU <br />585 B- D <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br />P marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable federal, state and international laws. <br />U <br />If 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 minimizes the present and future <br />threat to human health and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br />waste management method that is available to me and that I can afford. <br />0 Printed/Typed Name Si nature Month Day Year <br />U <br />V <br />Q� <br />Z <br />T <br />'I-7,."Tr iher"I-Ackn,3;�viediiei;Ze-ntotRe-c t of Materials <br />0 <br />= <br />N <br />S <br />Printed/Typed Name <br />Signature <br />Uj <br />P <br />0 <br />18. Trans Srf-6r Acknowled ement ofke—&iet of Materials <br />R <br />T <br />Printed/Typed Name <br />Signature <br />U_ <br />0 <br />: <br />I <br />U1.1 <br />19. Discrepancy Indication Space <br />0 <br />< <br />F <br />U <br />A <br />C <br />I I <br />1 <br />20. Facility Owner or Operator Certification of receipt of hazardous materials <br />covered by this manifest except as noted in Ite <br />Printed/Typed Name <br />Signature <br />T <br />Y <br />DO NOT WRITE BELOW THIS LINE. <br />DTSC 8022A (7/92) <br />EPA 8700-22 <br />• I Month Day Year <br />/ 1 '1 1 r: 1 -7)i <br />Month Day Year <br />Month Day Year <br />I I I I I <br />Yellow: GENERATOR RETAINS <br />