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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, U packed,,1 <br />marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulation. <br />1. <br />ae <br />0 <br />U <br />T <br />W It <br />0 R <br />N <br />W <br />LU 0 <br />sL T <br />O t <br />w <br />v7 <br />U F <br />A <br />Z C <br />I <br />L <br />T <br />Y <br />If I am a •large quantity generator, 1 certify that 1 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 ..1 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, 9 1 am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br />waste monaaement method that is available to me and that I can afford. <br />Printed/Typed NameI Signature I Month Day Year <br />{ 1j 11 <br />17. Transoorter 1 Acknowledgement of Receiat of Materials <br />Printed/Typed Name <br />19. Discrepancy <br />PriMTdName <br />DTSC 8022A (1/95) <br />EPA 8700--22 <br />(Month i Day <br />Year <br />l�l� <br />edgement of Receipt of Materials <br />Signatures Month Day Year <br />Space <br />rotor Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br />Signature Mont � � Year <br />DO NOT WRITE BELOW THIS LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />(Generators who submit hazardous waste for transport out-of-state, <br />produce completed copy of this copy and send to DTSC within 30 days.) <br />Stote:of Gaf iom Protection Agency <br />Fprm?Appravetf OMB n20 (Expires 93096) See Instructions OPI I11dC�C Of 6. � �� Department of TOxnc Substances Control <br />Pleam pruM; or type #, dasrg for;use on olilo (1?pikh) r. Sacramento, CnliforrYa' <br />"` ""erator's <br />UNIFQRM„HAZARDOUS <br />US EPA'ID`No. Manifest Document No. <br />2., Page 1 Inform aeion in the shaded areas <br />is not required by Federal law. <br />WASTE MANIFEST <br />7 1 3: 90f <br />I <br />3. Gene s Name and Mailing'` Address ' t <br />R <br />. <br />r',w <br />w <br />4. Generator's` Phone( s 11) r, -J'7 - &' 3 i (� <br />Z <br />} <br />d. <br />5. Transporter 1 Company Name, b. US EPA ID Number <br />a? <br />id zt Ck Ling”. <br />CA Dl41 ii 21"41 7 <br />—' <br />Q <br />7. Transporter 2 Comparry Name 8. US EPA ID Number <br />U: <br />a Q <br />9. Desi Facility Name and Site Address 10. US EPA ID Number <br />Z <br />O <br />Td <br />1C r lnc <br />255 Parr Blvd. <br />a <br />Rid, , 94801 G (11 0 91 41 5 <br />Z <br />—13. Total 14. Unit` <br />T Qua ` Wt/V01 <br />It 12. Containers <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />No. <br />Hazattlous Waste Solid <br />Waste Effpty Storage Tarsk. 0101 1 <br />r F' P <br />N <br />ob <br />e <br />N <br />b. <br />E <br />,. <br />meq, <br />R <br />J <br />'u 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, U packed,,1 <br />marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulation. <br />1. <br />ae <br />0 <br />U <br />T <br />W It <br />0 R <br />N <br />W <br />LU 0 <br />sL T <br />O t <br />w <br />v7 <br />U F <br />A <br />Z C <br />I <br />L <br />T <br />Y <br />If I am a •large quantity generator, 1 certify that 1 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 ..1 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, 9 1 am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br />waste monaaement method that is available to me and that I can afford. <br />Printed/Typed NameI Signature I Month Day Year <br />{ 1j 11 <br />17. Transoorter 1 Acknowledgement of Receiat of Materials <br />Printed/Typed Name <br />19. Discrepancy <br />PriMTdName <br />DTSC 8022A (1/95) <br />EPA 8700--22 <br />(Month i Day <br />Year <br />l�l� <br />edgement of Receipt of Materials <br />Signatures Month Day Year <br />Space <br />rotor Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br />Signature Mont � � Year <br />DO NOT WRITE BELOW THIS LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />(Generators who submit hazardous waste for transport out-of-state, <br />produce completed copy of this copy and send to DTSC within 30 days.) <br />A <br />S <br />ap <br />T <br />c w. <br />0 <br />of <br />R <br />. <br />w <br />Z <br />d. <br />U <br />J <br />'u 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, U packed,,1 <br />marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulation. <br />1. <br />ae <br />0 <br />U <br />T <br />W It <br />0 R <br />N <br />W <br />LU 0 <br />sL T <br />O t <br />w <br />v7 <br />U F <br />A <br />Z C <br />I <br />L <br />T <br />Y <br />If I am a •large quantity generator, 1 certify that 1 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 ..1 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, 9 1 am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br />waste monaaement method that is available to me and that I can afford. <br />Printed/Typed NameI Signature I Month Day Year <br />{ 1j 11 <br />17. Transoorter 1 Acknowledgement of Receiat of Materials <br />Printed/Typed Name <br />19. Discrepancy <br />PriMTdName <br />DTSC 8022A (1/95) <br />EPA 8700--22 <br />(Month i Day <br />Year <br />l�l� <br />edgement of Receipt of Materials <br />Signatures Month Day Year <br />Space <br />rotor Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br />Signature Mont � � Year <br />DO NOT WRITE BELOW THIS LINE. <br />Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br />(Generators who submit hazardous waste for transport out-of-state, <br />produce completed copy of this copy and send to DTSC within 30 days.) <br />