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See lnstructiolris on back o4 nom • Department of Toxic Substances control.
<br /> State of California�Environmental Protection Agenr y Sacramento California
<br /> Form Approved OMB No.2050-0039(Expires 9-30-99). titer.
<br /> Please pripl or type. Form designed for use on elite(12-pitch) Manifest Document No.' 2. Page 1 Information i,i the shaded areas_
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<br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consign hinhwa f alccordin accurately able internal ono{and nal anal government regular ons. parked
<br /> marked,and labeled,and are in all respects in propercondition for transport y. g y' 9 PP t 5
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<br /> ' It I,=a large quantity' generator,('certify that'l have a program in place to'reduce'the al c r enlume 1 available able tocity �ma`which ste ma,sizes hito the i present and fururee 1.have sre 1h eat toehuman health'_
<br /> i,tt0. practica61.and shati have selected the ppracticable method of treatment;storage,or diipos. - ly. V _
<br /> and the environment;OR,if I am a small quaniity'generaior, have made o,good faith'effort to minimize my waste generation and selecLfhe best waste management me}kod thaE is
<br /> O available to me and that 1 can afford.
<br />' Month Day Year
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<br /> W T 17. Trans orter i Acknowled a sent o Receipt of Materials
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<br /> 1 lQl 19: Discrepancy'Indication Spoee,
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<br />'I DO NOT WRITE BELOW 'THIS LINEN
<br /> t. Yellow TSDF SENDS,THIS COPYTOGENERATOR WIIWIN 30 DAYS
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<br /> IGenerators-who submit :ans
<br /> pari out of state
<br /> 'thazardous wasle'for t >
<br /> D75C 8022A'fl/94f produce completed copy of this 'opy and senc,ta'DTSC,w3t1'iin 30
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