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. Vx.� + U,..V 4.,,.VY <br />to print or xyps. (Form designed for use on (12 -pitch) typewriter.) Sacramento, California 1 <br />" UNIFORM H R US Generator's US EPA ID No. ane 2. Page 1 Information In the s a ed a <br />Dooumen4 Is not required by Federal <br />WASTE MANIFEST a I 'I .d sl 64 d d d d 1 I a I r r of law. <br />r <br />6. US EPA ID Number <br />Y d <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />7� <br />12. Containers <br />No. I TvD® <br />16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fully sno accurately cescnDec above oy <br />proper shipping name and are classified, packed, marked, and labeled, and are in all respects In proper condition for transport by highway <br />according to applicable International and national government regulations. <br />Unless I am a small quantity generator who has been exempted by statute or regulation from the duty to make a waste minlmization.certification <br />under Section 3002(b) of RCRA, I also certify that I have a program In place to reduce the volume and toxicity of waste generated to the degree I <br />have determined to be economically practicable and 1 have selected the method of treatment, storage, or disposal currently available to me which <br />minimizes the present and future threat to human health and the environment. <br />Printed/Typed Name I Signature rp Month Day ear <br />Z. 11�IT 17. Transporter 1 Acknowledgement of Receipt of Materials <br />A Prl !! m -^d-- <br />Nae --.- Signature <br />P v <br />o 1S.Transporter 2 Adknowfedgement of Receipt of Materials s <br />T PrintedlTyped Name Slgn(ktur <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />L <br />1 <br />T 20. Facility Owner or Operator. Certification of receipt of hazardous materials covered by this manifest except as <br />v _. <br />,DHS 6022 A (11185) YELLOW: GENERATOR RETAINS <br />(EPA 6700-22) <br />n <br />