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i' .See 1 't udions on:0Qf6W Sacramento,�
<br /> State of California Envirotimenedl P�tpgtiofleA939-99) F'
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<br /> e Fo'1'+n desi nee-;it use on e6te.f 12 Manifest Document t ko. is not require
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<br /> Federal(raw
<br /> Please pant or yp r' ° nror s US EPA ID No.
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<br /> UNIFORM FiAZAItDOUS } ' I `', of
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<br /> 1NASTE WAN !' A:Stale ManiFHest bacrat Nu, l a F
<br /> Generalor's Nome an�Momrilp Address
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<br /> O 15 Special Handling Instructions and Addittonal Information is- k r u eery}1
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<br /> ir• 16.-GENERATOR'S CERTIflCATION: 1 hereby dec(ore that-the contents of this'consirri are fully and accurately described above I per
<br /> shipping dome°and"aredassified pocked,
<br /> Q• marked;and labeled,and are in all respects in proper condition for transport by highway according to applicable mteraotional and notional government regulations:"
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<br /> I cerci that I have a pre rom'in place to seduce the volume Grid too cal oble to me which m n lizas he present and future thdreat to hOmoe fsealtfi
<br /> If 1 am a large quanti .generator, ,ply
<br /> nmenl `KovOR,if I am a small quantity' generatorgl have mada'a:goad faith ef#ort eo minimize my waste generation and select the bedt;waste'rnanagettieni mehod lhat'is'
<br /> i practicable and that I have selected the raclica6le'methotor treatment,a a:90 d f disposal to mi i
<br /> ,,and he enviro
<br /> Oavoila6le'a me'ond hot I can'affbrd. "'Month l Day Year .
<br /> Printed/T Nome. f�. ate, 1
<br /> Mont Day;
<br /> T' ,17.'Trans orter 1 Acknowledgement oYear
<br /> f Recei t of Marerio.k S' nature �'f .r:
<br /> f pad/xP�Nome.'
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<br /> Ct' r t
<br /> LU -p Month Day_ Year
<br /> sL p 18. Trans oder 2 Acknowled ement of Receipt of Materiels Signature
<br /> TPrinted/TYPed Name, - - - - -
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<br /> V19.Aiscrepancy Indication Space
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<br /> C.
<br /> Month Doy Year
<br /> 20. Focili Owner or Operator CertiEicalion of recei t of hazardous materials covered b this manifest exce has noted in flam 19.
<br /> ' Signature
<br /> 1 T Printed/Typed blame'
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<br /> DO-`NOTWRITE BELOW-THIS LINE.'
<br /> Yetlow: GENERATOR RETAINS
<br /> DTSC 8022A(1/991
<br /> EPA 8700-22;
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