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<br /> State dF California—EnvironmeMbl Protection Agency _ ,.��, --�5- ! r j _Sacramento,-Cali4ornra -1
<br /> Farm ApPreved+01 46 No.2050-0039(Expires 9.30 99f P ter.. c InForm_ation in the shaded areas
<br /> Pleose printor typo. Form designed For use on elite(Z2 rkhJ A� 1 Manifest Q°wmant No. 2'.Page
<br /> 1 ss not required by Federal law.
<br /> 1. Generator's US EPA l0'No
<br /> UNIFORM HAZARDOUS Z' �" �, of f
<br /> WASTE,MANIFEST . (� 2 Q i
<br /> A Shite Manifest Document Number
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<br /> 3. Gen- erator's Name and Mailing Address
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<br /> n 6. US EPA ID Number,' h t f a
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<br /> 7.'Transporter 2 Company.Name
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<br /> _ID Number
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<br /> 'V 9. Designated facility Name and Sita Address
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<br />' �a Pazlit: Facfli.l '..S
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<br /> 12. Containers 13 ,Total 14 Un)10
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<br /> No- T e _ Quantity ' Wt/Val I'Waste Number _
<br /> 11. US DOT Description(including Proper$hipping Noma,Hazard Class and ID Number_ e $tate a
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<br /> 16. GENERATOR'S CERTIFICATION: 'I hereby decldre that the condition thansoort by highway,�ccording'torapp(i able international Y nd nos oonl government egulatlio�,5, packed
<br /> be economica
<br /> V marked,and labeled and are in'all respects!n proper co P =y
<br /> I ave o ro'ram in place lv reduce the volume and toxicity 0F.waste generated to es idha r resent ani future thinereat o human health
<br /> .it`I'am a large quant! generator (certify that I h p g to me
<br /> a. - practicable and that I have selected the practicable emothne ator}itha a mdde,v good fo h effort 3oosal rm nimize my.w ste generation[and ielect the
<br /> a-
<br /> management method that is
<br /> �. and the onvironment;OR,if I am a small quantity g
<br /> 111 available to me and that 1 an afford Month. Day. ; Yeor
<br /> O � Signature•--'�-"'�,� � ,. �: i, -
<br /> Printed/Typed Name - _
<br /> w S 17. Trans iter 1 Acknowle —rif of Recei 1 of Materials Month, Day Year
<br /># a -A Pri - dName"LU - 1 - _ •, Signature'• -
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<br /> P 18. Trans omit 2 Acknowled eme t of Rec., t of Materials Month Day Year y-
<br /> Signature
<br /> Printed_/Typed NameLi
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<br /> s V 19 Discrepancy_Indication Space'
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<br /> L Month Day Year '
<br /> l 20. facili Owner or O eraror Certihcahon of recei^t of hazardous materials covered b 'this manifest exce t as Hated in Item 19
<br /> Signature
<br /> T: Printed/Typed Name.
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<br /> . .DOMOT WRITE BELOW THIS LINE
<br /> Yellow:', GENERATOR RETAINS
<br /> DTSC 8022A(1199)
<br /> EPA 8700-22
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