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pn Deportment oF_Toxic Subslonces Control
<br /> `t£alifomia—Envirornmental Protection Agency See Instruettotns or back of- g Sacramenio,California
<br /> turrn Approved OMB No.'2DS0 X0039(Expires 9'-30.99E ;iter`:. '� dy''" r - '
<br /> ;flease print'or type, Fom designed lar use onrelite f 12-PifchJ Manifest Document No. 2. Page 1 fnformotion in the'sh6ded areas ,
<br /> 1 Generato_r's US EPA a- is not required by Federal law
<br /> UNIFORM HAZARDOUS aF "
<br /> WASTE .MANIFEST 13.'' �3 ,?` ; `} 3 _` i t 5 } g
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<br /> 16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of ens ort bn hinhwo alccordin8 to opplica6le in lernational and nal onlol Bova nmarit re8 las ons. packed .I
<br /> Q marked,and labeW,and are in all respects in.proper condition fo p Y highway 3
<br /> If I am a large quantittyy generator,!certify that I have a pro in m place to reduce the volume and toxiciry of waste genefated to the degree I have determined to be economically' r
<br /> i practicable and lhat.f'have selected the practicable method of treatment,storage,or disposal currently•available,io'me which minimizes the present and future threat to,human health
<br /> N and the environment;OR,if I'am a'small quantity generator,I have made.a good faith effort to minimize my wrists.generation and select the best waste'management.method that is
<br /> a available to me and shot can afford. '.'
<br /> fl Signature'' F) Month- Day. Year
<br /> I Printed/TY��a Name
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<br /> 17: Truss rte 1 Acknowfed emehi of Recei t 6f Materials >
<br /> ,. Month„ Day Year
<br /> Signature
<br /> A PrintedlTyped Name
<br /> f 0 p 18. Trans orter 2 Acknawled emenl of Recei t of Materials Month Day. Year
<br /> RT Printed/Typed Name Si nature
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<br /> -19. Discrepancy Indication Space
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<br /> 20. facility Owner or-O erator C tifi ation of recei I of h v materials covered b this manifest exec t as ed in Item'19. /
<br /> i- "Signature ` Month Day Year_
<br /> 'T Printed/Typed Name.
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<br /> DO-NOT WRITE BELOW THIS'LINE.,,
<br /> Yellow., TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS.-
<br /> (Generators who submit hazardous waste far transport 60-61-state
<br /> t DTSC 8022A(1/99] praduce-Completed Copy of this copy and serd to DTSC within 30 days.)
<br /> EPA 8700-22 '�
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