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<br /> "$tate of Colifornia--Environmental Protection Agency _ -may .- '
<br /> Form ApprovedOMB No.2060-00- for
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<br /> Please pcini or type.-Farm designed kr use on elite[12-pitch) ,,yrrfer. Manifest Document N is not required,by Federal law...-- .
<br /> } ,rerator's US EPA ID NO.-
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<br /> Z' 15 Sped Handling lnstructions and Addifionnl Informatron .
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<br /> 15.'GENERATOR'S CERTIFICATION! I hereby declare that the contents of this consignment are fully and accuiatefy described above by proper shipping name and are classified,packed,
<br /> ]_ Q marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and natior cl government regulations
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<br /> ^' m a lar a uantittyy generator,I certify that!have o pr in in place to reduce the viilume and toxicity of waste gen erated to the degree l hove determined to.be.econoinically
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<br /> practicable andgthat I have selected the practicable method o(Ifhove made a�good Eadh effort toosal rrmmim ieavamy(waste genere to me raiionland select tjimizes the he b sttwasdleumanbgam,ant method hha tis
<br /> and the environment;OR,if!am,o small quantity generator, g, - -
<br /> CC available to me and that'(can afford Month Day earn.
<br /> Sign fur ' / (� / `� C57
<br /> r Printed/T Name �r�' 1 /
<br /> T 17. Trans orter 1 Acknowledgement of Receipt of Materials r Month Day
<br /> Year
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<br /> Day Year
<br /> Ia. Trans rt--2 Acknowled emanl of.Recei tof Matenafs Month
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<br /> U' _ '19. Discrepanry lndicafion'Spoce -
<br /> L r D erator Certification of.recei I of.hazordous materials covered m except as no Item 19..
<br /> ..1 20. ci' Owner o -Month-. . I Day- Yeah
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<br /> :DO`NOT WRITE :BELOW-)HIS
<br /> Yellow: TSDF SENDS-THIS COPY TO,GENERATOR WITHIN 30 DAYS.
<br /> (Generatori who submit hazardous waste far, transport out of slate,
<br /> DTSC'8022A(1/991 produwe completed copy-of this copy and send-to DTSC within 30 days-1
<br /> .EPA B700-22
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