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_ R�b, DepartmenY.of Toxic Substances Control
<br /> State qF California Environmental Prate Agency see InstratiO�Ts';Oh'�C1CIC O�' i '$atranienlo,California
<br /> Fgroii pP7oveJOMB No:2050-0039{Expires 9.30 94)
<br /> --Pl tine prir 'oF type. Form designed For u on efite f 12"Pitch�_ ter. 2..Poe 1 'Information in the shaded areas '
<br /> 1. enerator's USS PA ID No. Manifest Document'N g is not required by Federol low..-
<br /> UNIFORM HAZARDOUS A
<br /> WASTE MANIFEST. C 3
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<br /> A State Manifest DacumenY S[umber
<br /> 3. Generator's Name and Mailing Address . Pat GUill�finety
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<br /> Specicil.Hondling Instructions and Additional Inform
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<br /> ¢ Gloves & Gngglas r k' ockto�x, CA 952I5
<br /> L Ering. $'�1�9 689 5607
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<br /> hat the contents of this cons; nioeni are fully and accurate) described above by shipring
<br /> ernmerit re ulations _-
<br /> declatef nationvl- 9
<br /> TION: I hereb yy t rnationaf and. g .
<br /> RATOR'S'CERTIFICA Y g n 'Yv a fitable in e
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<br /> v a roram in~lace to reduce the volume.and toxicity.of wesre,genereted to the degree I have deiertri'ined to be'econoniically
<br /> df I bm a large quanYiy.generator I caFtiFy that I ha a p g P y
<br /> d raclicable-and(hat Rave selected the prgclicabla methCd of treatment,siorbaod faidth eFfoiYtorm nimize imy neo a generiati n o d select the best Brassie management method that l!s y
<br /> _ and the"er friFanment;OR,if I cim a$ma41 qugntiy generator,},I have,made a g , F c
<br /> 0 ovaitable to me and that Y can ofF, Month .Day Year
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<br /> STEA AS �UAL1 ED DUR SPA.
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<br /> i 20 Fa i Ctw at or0 erator Certificati of cei f of hazardous materials covered= !as anises,exce as noted i Hem 19 Doth Day Year
<br /> 7 Pri Y /T ed ami '} Signature A D
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<br /> DO NOT.WRITE BELOW-THIS. LINE.
<br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR.WITHIN 30 DAYS,
<br /> j (Genera,ors who submit hazardous waste for transport out-of-state,'.
<br /> j DT5C 8022A fl/99) pioducecompleted copy of #his.capy and
<br /> ` send to'DTSG within 30 days.) '
<br /> EPA 870-22
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