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<br /> �_ ��`��-� �� _... • T - rs�(�, - Department of Toxic Su6starsces Control
<br /> Stole.of California—Environmental Protrrcfsi�en-^� See InstrldioF45 OFl�SOCI�of- Sacramento California-..
<br /> Foin&pproved OMB No.2050-0039(Expires 9-30-99)P .;vrirer -
<br /> please'pt nt ar type. Form designed far use on elite 112- itch Manifest Document No. 2. Page 1 Information in the,shaded areas' f
<br /> _ 1 Generator`s US-EPA ID No:. - is not required by Federal law.
<br /> UNIFORM HAZARDOUS !� of
<br /> WASTE MANIFEST �.. ✓ 3 _ x
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<br /> a 9. Designated Facility Name and Site Address
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<br /> l6. 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 packed !
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<br /> marked and labeled,and are in elf respects in proper cond iron for transport by highway occording'fo apphcabfe mlernafwncl and national government regufatians r? s at
<br /> e ucnti enerafor,I certify that!have a pro nom in place io-reduce the volume and toxicity-of.waste generate n mizeto t s he rpresent nd fu1 re threat Fba human health
<br /> If I atria large q H g g
<br /> i a practicable and that I have selected the practicable method of treatment;storage,'or disposal currently ayailabfe to me which mi i
<br /> w and the environment;OR,if I am a small quantity.generaior;.l have mode a good faith effort to minimize my waste generation and select the-best waste management method that m
<br /> available ho me and[hat l can'aFford.
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<br /> Primed/T 'd Name ` �' fTnatura
<br /> T 17.,Trans otter l Acknowled ement of Recei t o Materials
<br /> R Si ature ' ' Month v Da Year
<br /> I A -tinted/Typed Na_me ,`,
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<br /> p 16. Transporter 2 Acknowledgement of Recei t of Materials Month, IJpy Year
<br /> R" e Signature
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<br /> U . 19: Discrepancy In SpaceA 71
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<br /> -20. Fadlz -Owner or.0 eraior Certification of __;ipt of hazardous materials covered'b' this manifest ce t'as ted to Hem'I 9 Month Day. Year
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<br /> k DO NOT WRITE BELOW THIS dWE :y T
<br /> Yellow TSDF SENDS THIS COPY TO GEN£RAT�R-WITHIN 30 PAYS
<br /> {Generators who submit hazardous waste.for t ansport ovt of stale
<br /> OTSC 8022A f 1199 produce completed ropy of this copy and;send fa'DTSC'within 30 days
<br /> EPA$700-22
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