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State of California--1 ealth and Welfare Apeney •r' }^y. f > ,. q '. .•
<br /> Form Approre OJ.I �20t;V-X39{p Qtreal .flee W�faaitlt Sarvies
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<br /> J;Additional Descriptiofts Materkals Listed Above
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<br /> CO 16, Special Handling Instruction&and Additional Informalionr
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<br /> GENERATOR'S CERTIFICATION. 'l hereby declare that the contents of this consignment are fully and accurately desertbed above by proper shipping name.
<br /> and are classified,packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable InteatkanaI and
<br /> Wnational government regulations. x m�; 7 ,
<br /> e!r i}j am.p larg"uamjWgsnerator,I-certiy'that-1 have a program.1A place to reduce-1he,valums-and-tw�e of wasto generateci,to the•dggrr4ii+a�la deterrrjip
<br /> At4 to be economically practicable end that I have selected the practicable method of treatmont,rslorsge;or disposal currenty'avallable`to mef htoh minlmixes
<br /> present and future threat to human health and the environment;OR,It 1 am a small quantity generator.I have made a goodj<h efjort.to miniitllze,my.waste''
<br /> U generation and select the beet wade management method that Is available to me and that I can afford. --,t,.f' 0., 15?ti ta♦
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<br /> :W T 17. Transporter I Acknowledgement of Receipt of Materials
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<br /> W O 18. Transporter 2 Acknowi dgement oT Receipt of Materials r;A• a `'!." ''tom "" ta:;
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<br /> F 19.,Discrepancy Indication Spacem5_1"el
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<br /> I 20, Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted In Hem 19.
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<br /> DHS 8022 A(1188) Ywrx. y-� p4 r
<br /> EPA 8700 -22 DO I�'�Ot f IOW U4IAe
<br /> (Rev.8-88)Previous editions are obsolete.
<br /> Yellow:TSDf SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS
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