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y'State Gf CalifocniarEnvirorrmeniaf Protection Agency
<br /> SCB Instructions on Daukus/r $ac ramento;'CahFGrnia
<br /> >r 0A 46' 2050-0039{Expires?-30-991.-
<br /> (arm Approti - _
<br /> Please pw+11 o e' lormrdesrgned for use on elite I12 p'tchl-� a Manifest Document Nc 2 Paye 1 Information in the shaded areas`
<br /> v5kPA ID No - is not required by federal low
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<br /> WASTEMANIFEST :. CA 2 5 4 0 :.6 5
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<br /> . ,323 2&4-5200' �
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<br /> 7 Transporter 2 Company Name
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<br /> sin V 9..Desegnoted Facility Name and Site Address ' - -
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<br /> WY/Vol Y,Wos1e Number -
<br /> US DOT Description linduding Proper Shipping ama,Hoz ird Class and ID Number} $tate °c $ s
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<br /> RE7ERFIQCFD WASTE WAS RE NED. FL4 EPA/Ot9Iii,•- -s e�
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<br /> Q 15 Special Handling Instructions and Additional Informagon '.��� � i 4 1C.JC7�� �
<br /> r Sktci; :.: 45205
<br /> -X339—x£07': k
<br /> ' TOR'$ CERFIFICATION: d,hereby declote that the.contents ofhicarisi nment are fully grid aceuratal described a6'ave by proper ship
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<br /> and ore classified pec d,',
<br /> '16 ,GENERA k P g Y,, g PPy
<br /> 4' mark8d,'and Labeled,and are in dll respects,in proper,condrtton r trans ort by ht hwa accordan to ci hcc6le internotional'and nottona government regulations
<br /> S A V r M h ., - Y � r,
<br /> i to`reduce the'volume and toxicity'of waste generated•to the degree l have determined to iii economtcall
<br /> 1f l,am a Idrge1quanhly generotor,'Lcertify that I have a"program in',plac y
<br /> d racticable.and that I have se act- the,praclimble'methbd of treatment,storage,or'disposal currently available tome which minimi the prosent and:futura,thre ento h I 'l lh
<br /> est waste manpgpm r _
<br /> ¢nd'1he-artlri_ronment;OR,'if Lama small quanfity generator I have made a good Faith efFort to minimize my waste generation and select the b- r a r
<br /> a avoilablp 10 me.'and'thot I con pfFord 1► _ e V
<br /> Q °Mbnih r Year
<br /> Signature {
<br /> Y Pr' d/Typed dme
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<br /> cu ndwled lodgement of Recai t of MaienoSs'
<br /> Ack Month' Da Year
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<br /> orier.2-Acknowled ement'of Recei 1 of Mlatenals-:- hAonth pay' - Year
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<br /> �K Q .:R ' . /Typed Name
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<br /> s `I,- 20. facili Owner oro era ,Ce ification f rai f of hazardous materials covered b th s exce t as'no em>19 .'N,onih'. Day i"x�Year'
<br /> g ; Printed/Typed Nome f
<br /> Sign
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<br /> iDO'NOT WRITE BEL W .MIS,.'L :.
<br /> 7 t Yello TSDF=SENDS THIS,COPY TO GENERATOR WITHIN 30 DAYSIx
<br /> JG.6 rotors-whcI mit hazardous waste far trcnsport:'out 6F-state,
<br /> z withi -30 days.)
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<br /> x'; :EPA 8700-22 =
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