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5777
<br /> r t Deportment of Toxic Substances Conlral ;
<br /> Slate of California—Environmanfal Protection Agency S60Qructions DI1 F]Gtk OT Sacramento,California
<br /> Form Approved OMB No.2050-0039(Expires 9-3t:991 f A, }
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<br /> 1 Generator's US EPA ID No.' j } is not required by federal lavi. . I
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<br /> 1 G..GENERATOR'S CERTIFICATION:-1 hereby declare that the contents,of_this consignment are fully and accuratelyy described above 6y propel shipping name and are cfassi::. packed
<br /> Q, marked,and labeled,and.are.in all respects in proper condition for transport by highway according to appllgable mternahonaf and national government regulations
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<br /> } ucmfi enerator,'I:cerhfy theft have a pr ram in,ploce to reduce the volume and toxicitry 0'to me which amdnimizes the pre aril and futume Ihdreat
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<br /> human health
<br /> I If.l am a large 9 9
<br /> "a practicable and that I ave selected the practicable method of treatment,storage,or disposal currently a a
<br /> N and the e_nv_ironmenh OR,if k am a small quantity generator,I have made°good faith effort ro mmlmae'my waste generation and select the best waste management method that is
<br /> available to me and that!con aFFS�d-
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<br /> LLJ T 17.'Transporter 1 Acknowled amen!of Recei Y of Materials - - �> Year!-
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<br /> 18. Transporter 2 Acknowled errment of Receipt of Materials _ Month Day Year
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<br /> U19. Discrepancy Indication Space
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<br /> 20. Facili 'Owner ar O erator Cerhhcation of recei 1 of hazardous moleripls covered b�,thts mamFest exce t as noted mJtem 19_ ”" Month. ,,J`D4 4; . Yeor:
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<br /> DO NOT WRITE BELOW PHIS LINE r
<br /> DTSC 8022A{1/99► Yellow: .GENERATOR RETAINS'
<br /> EPA 8700-22
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