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'State of Cal ifornia—Environmentol Protection Agency _ t
<br /> '-Form Approved OMB'No.2050-0039(Expires 9-30-99) e'Seg Instruetlons Ofl hQC�C Of Department of Toxic Subslancas Control
<br /> • } I Sacrainento,California
<br /> Please print.or type- Form designed for,use on elite f 12-pitch)„ iter.
<br /> 1 enerator s US EPA ID No. Manifest Document No 2. Page 1 Information in the shaded areas j
<br /> UNIFORM HAZARDOUS :is eat required by Federal law.
<br /> WASTE MANIFEST, C 9 ? 3 1 aF
<br /> A* State Mnmfest DocumentNumber
<br /> 3. Generator's.Name and,M'ailing Address r {
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<br /> 5. Transporter!CoLO
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<br /> m 7:,Transporter 2 Caisipany Name 8 US EPA ID Number E r5tdfe Ti di�sporter a FD[R serytld 1 gt " �# _
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<br /> �V 9, Designaiad Focihfy Name and Site Address 10 US EPA ID Number G Siete Fadillly s ID
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<br /> Z 15. Special Handling Instructions and Additional Information. t 1l� !✓`
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<br /> 16.GENERATOR'S CERTIFICATION: `I hereby declare katal;contents of this.consignment are fully and accurately d 3scrib"ed above by proper shipping name and are dassiFied,packed,
<br /> V ,marked,and labeled,and are in all respects in proper:condition for transport by highway according to applicable internatronol and national government regulations -
<br /> if I am a lar e,-oanliy enerator;I certi that Ihave`-a' rog'ram tr Idea to reddce'1he volume and toxicity of waste generdted ro the degree I hays determmed,to ba economically }
<br /> a practicable and9liat I hays saI "d the� cticable method of ireatme t,storage,or disposal'kurrently ovailableao me which.minimizes the present and fu to threat_to human hebfth u
<br /> and the eriykon Hent;OR,.if Lo ;o amdll q'ydntity,generator,1 haveiinade a good Faith effort 'mimpuze my este genarafion.ond salectrth'e best wostd mdnagemenl method that is
<br /> available to me and that l cart eiloid ' Y - "
<br /> PFiisfed�Typed Name ,. r Sign fu a ` a�� yy Month Day`.. Year
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<br /> LU i 17. Frans orter 1 Acknowlad ement of Recei t of Materials
<br /> w 'h, Pri d/Typed N me Sign cture on Day = 'Year'
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<br /> `- O 0 18. Transporter 2 Acknowled ement of Recei t of Materials r "
<br /> Montll Day . Year
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<br /> V19.,Discrepancy Indication 5pace'.
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<br /> 1 20- Facility Owner or Operator Certification of racei t of hazaedous'matenals covered b this manifest except us noted in Item
<br /> T Pr{nted/Typed Name -cy r Signn Day
<br /> tore Month Year
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<br /> : Do'NOT WRITE BELOW,THIS LINE
<br /> DTSC 8022A(1/99) Yellow GENERATOR RETAINS*'
<br /> EPA 8700
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