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State of California—Environmental Protection Agency 6, be artment of Toxic Substances Control
<br /> Form Approved OMB No.21750-0039[Expires 9-30 99f � See If15tfUC�fC05 Olt baC�C OF•p; P. Sacramento,California
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<br /> �. 1, c eneratord US'EPA ID;No. - Manifest Document'No. 2: Page,1 r Information in the shaded areas
<br /> UNIFORM HAZARDOUS is not-required by Federal law
<br /> .,-..::,WASTE
<br /> MANIFEST
<br /> 3. G ner rs Na ana din Add e s A State Manifest Document Number
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<br /> I�V 9, Designated Focility Name and 'lo Address 10 US EPA ID Number `$ }a t � ON
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<br /> '�'� - .,. 12. Containers 13. Total 14:Unit sF ,'l '�'s's"
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<br /> Z 15.,Special H ndlin In it ctians and A d ' nal Information e s-
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<br /> GENERATOR'S CE ICATI r I here6 declare that the contents of this'onsignment are fully grid ac rately deicribed above by proper shipping name and are classified;packed;f
<br /> < marked,and labeled,and are in all respects in proper condition For transport by highway according i'b applicable mtcrrtatronal and,national government regulations
<br /> if I cm a.'lorge quantiy�y generator,I certify ihah I have a prdggrdm,m places to reduce the volume and,toxicity of waste generated to theZfegree I have determined to be economically
<br /> a practicable and that,I:have selected the racticable method of.lreatm,,nj-'storage,or disposal currently available lo.me which minimizes tha present'and Futuro threat ro human health _<
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<br /> and the environment;OR,if I am a small gdantiy generator,I-have ma�e a good faith effort for minimize;m_y waato generatiiin and select,the best waste management method that is
<br /> ceavailable to me and that I can offord. .' t
<br /> Printed/Typed Name jfgli�citure s �, Month ) Day Year-
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<br /> 1' 17.-Transporter 1 Acknowledgement of Receipt of Materials T�
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<br /> fi p 18. Trona arter 2 AcknoMed eiment of Receipt of Materials
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<br /> f 20. Facili .Owner or O eratoe Certification of receipt of hazardous-materials'covered b this manifiiWexce t as noted in Item 19 ."
<br /> T" 'Printed/Typed Name, Signature Month Day :t.Yeor- j
<br /> DO NOT.WRITE BELOW
<br /> THIS.LINEr
<br /> DTSC 8022A 11/99] Yellow:' , GENERATOR RETAINS
<br /> .,EPA 8700-22
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