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State of California—Environmental Protection Agency
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<br /> Form AgprF '. Q No.2050-0039(Expires 9-30-991 P writer. : -
<br /> yE- typ g Mnifest Document N 2• Page 1 Information in the shaded areas
<br /> Ply print or, , e. ,Form�esi ned for use on elite f I?" rFch ierators
<br /> IS EPA ID No, is not regvlired 6y Federal Ipw.
<br /> UNIFORM HAZARDOUS ' /'� of
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<br /> Z1$ Sp'eciaf Handling Instructions and Additional Information
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<br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this cansi omen[wa ohwrdin c10 vppli able international yand not nal go a nment egvlaf o^sified,packed,
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<br /> t U marked,and labeled,and are in all respects in proper cand+tion.for transport y h+gh y g
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<br /> 'If fall a large q'an"'' generator,d cal that'I have'a progra atme It storage,orediseo all currently v+ai able t omew which m nimiies tnerated to the dfa�preser l and fu�urc Its eat o•huma8 health
<br /> {{' practicable and that I have selected the ppracticdble method of tie 9 P
<br /> F' and the environment;OR if I am a sma11 quantity generator,I hare'made o'good faith effort to minimize my wasre;gene�atin_andselact the best waste_monogemenF method that is
<br /> available to me and that t can afford, _
<br /> + Month Day Year
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<br /> W nt of Recei t of Materials Month Day Year _
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<br /> 'p - 18. Trans orter2 Acknowled ement of Receipt of Materials F Month Day Year
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<br /> [' 'U .19. Discrepancy In Space ,-
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<br /> E ner aro erator Certification of recai t of hazardous materials covered b this'mon+fest exce t as noted in Item 19. Year
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<br /> - . . NOT WR3TE BELOW TH15-'LINE.; .
<br /> Yellow!. -GENERATOR:RETAINS
<br /> DISC 80224(1/99)
<br /> EPA 9700-22
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