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State of Colifornfa—Environmental Protection Agency: ,f'y, Seg Instructionson Ducawill. Socramento,.Calitornia
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<br /> Plsihse print or type..,,Form designed for use on efrfe 0-20'itch) r• Manifest Document No.
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<br /> O 15 Special Handling instructions and Addihonol Information ENffiRCfF,NCY RESPONSE-PRQTFCTr E CLOT14.1N T
<br /> Z 1 . =, San Joaquin Fitter.Recycling (559)498-0240
<br /> E N= y shi in name and are classiF'sed,packed,
<br /> .16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment ora full and accurately described above l proper PP 9
<br /> t marked,and labeled,and are'in all respects in pchper condition For transport by highway according to
<br /> international and nations government regulafions. :economically
<br /> to the
<br /> have
<br /> IF t am b large quantiy generator,I certify that};have o program in nit storage,or disposal curreume nt y av!oi chis ioof ame ste wh ch mn mizes the preslent and Futurre threat-to
<br /> ehuman health
<br /> E: practicable and that Rove selected the procticofjle method of treotme g P
<br /> and the environment;OR,if I am 6 small quontiy generator,I have made a good Faith effort to minimize my waste generation and select the best waste management method fhiit is
<br /> ill available to me and that I can afford.
<br /> O, Signature s Month Day Year
<br /> l}J Printed/Typed Name_ - Q
<br /> ts., 1 17, Trans orter I Acknowledgement of Recei 1 of M erials
<br /> Month Da Year
<br /> -E Printed/Typed Name Signature j O
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<br /> cknowled ement of Re cei t of Materials Month Day Year
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<br /> Fac'li Owner or O erator Celificalian of recai t of hazardous motenols covered i m est ce t as note em h.•month Dd'y,. Year
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<br /> DO NOT WRITE BELOW"THIS LINE.
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<br /> R WITHIN 36'DAYS.
<br /> Yellow: TSDf SENDS THIS COPY TO GENEgAT
<br /> ' (Generators who submithazard-ous waste for L transport out-of-sta,
<br /> te,
<br /> DISC 8022A(1/99) prodtite completed copy of This copy.ond sand to DTSC within 30 days.)
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<br /> 4 EPA 8700-22
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