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<br /> ' p4portment of To Substances Control.
<br /> 3tafe,�E.Califoist+p�Environmenfal Protection Agenry ?! - See If75ttUCt101Ts OR back of q4 Sacramento,Ca4ifornia
<br /> p ed OMB No.2050-0039,(Expires 9-30-99) { . ' S
<br /> Form pPrvv itch der
<br /> Please-prinh�oraype.;form_designed For use on elite(i2-p ,l Manifest Documen!No:–! 2. Page 3 Information in the shaded areas
<br /> 13 �_nerator's US EPA,ID No s nof,required 6y Federal law
<br /> UNIFORM HAZARDOUS
<br /> WASTE MANIfEST ", i •� ;
<br /> tt A-State MansFeaf 0acutnent Numfser
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<br /> 3 Generator's Nama and Mail
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<br /> 16. GENERATOR's CERTIFICATION: l hereby declare That the contenname and.cire'jC
<br /> ts of thi^Soon gn boob are alccor-ing fo appli a61e iniernational''and nalia al gove nment regulahons. packed
<br /> U marked,and labeked and are in all respects in proper conddion for tra p y 9 Y „? z
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<br /> eneraior,I cerci that I have a pr' ram,in'place to reduce the vdfume and toxiuty'oE ware which m enerateo rnizes'he p went and futrie 1-'kava
<br /> are thdreal be
<br /> human'hedhh
<br /> If 1 am a large quantity g
<br /> i-a predicable and that I ha e.selected the practicable method.of-treatment,storage;or drspasal'currenrly available to
<br /> and the environ nentyORif'1 am a small quantity-generator,I have vdde o good faith effort to mimmiie my waste generation and select the best waste management method that is 1
<br /> ` � -
<br /> 0 available to me and that I can afford. Month pay Year
<br /> Pr'inte
<br /> ed Name,
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<br /> Ur .T,- 17,'Trans orter 1 Ackriowled emeM of Recei t of Materials " Month 'Day 'Year
<br /> Printed/Typed Name Signafd
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<br /> P y x Year
<br /> u„ f1 18. Trans orter 2 Acknowled errant of Recei 1 of Materials - Morith - Da ri
<br /> 0 R y Signature
<br /> T Printed/Typed Name:," {
<br /> V 19,Discrepanry Indication Space
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<br /> f 20. Facili Owner or O orator Certihcotion of receipt of hazardous materials covered b this iisnifest exce t as noted in Item 19 Month- Day Year „
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<br /> T Printed/Typed Name %
<br /> Y „ x,
<br /> DO NOT_WRITE BELOW,THIS LINE,
<br /> Ye41ow: GENERATOR RETAINS
<br /> DISC 8022A(1/99) s„
<br /> EPA 8700-22
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