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Department of Health Service <br />Toxic Substances Control Divisic <br />Sacramento, Californ <br />2. Paget Isformation In the shaded areas <br />014 / I Is not required by Federal law. <br />�CMlllm <br />411, "A, I <br />............ <br />A <br />iiiail —fftrAW4 <br />L 4' <br />GENIMM'S CER"VAIM' I hereby declare that the cordealsof this consignift0ft are fully and accurately described above by proper shipping name <br />WW No claSsifted, packed, aterited, and labeled, and we in sit respects In proper condition for transport by highway according to applicable international and <br />national nt <br />If I am a ISMif quantity 96fterldor. I cerft that I have it prow" In place to reduce the volume and toxicity of was* pamated to the degree I have determined <br />to be oconomil"Ify Ifftallemblilf end that I have selected method of treatment, storage, or disposall currently available to me which minimizesthe <br />> present and fat ure OOW to hursail-heaft and *a ==11"I't. "It I am a small quantity generator, I have faaft a good faith effort to mialmize my waste <br />WMWOtift and SW*4 Ow bakwailft #0099wftM MWW Is, available to me and that I can afford. <br />Printed /Typed Name, Signature Month Day Yew <br />R 8 <br />A Printed/Typed Month Day Year <br />N <br />SSAM& <br />P ---I== �k�' % <br />0 le. Tra"pader It of re;*w— ;f —MakWWIS <br />R <br />T P*dOdltyP*d 11110100 Signature Month Day Year <br />E <br />a .. 19.'6 <br />—f*PaftOYMd1"t1On ape" <br />F <br />A <br />C <br />I <br />L <br />1 20. Facility Owner or Opwator M;#-= 6-f recOlp of hatardous, materials covered by this manifest except as noted in ftem 19. <br />T <br />y Printed/Typed Nam Signature Month Day Year <br />DHS 8022 A (1/88) Do Not Write Below This line <br />EPA 8700-22 <br />(Rev. 9-88) Previous editions are obsolete. <br />