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<br /> :State of California—Environmental Protection Agency SacramenEo,California
<br /> ` Form Approved OMB No.2050=0039(Expires 9.30-991 2 Pae 1 Information in the shaded areas
<br /> Please print or'ype. Form designed for use on elite{T2•p, oewrifer. Manifest Document 9
<br /> Venerator's US EPA ID No is not required by Federal law.
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<br /> WASTE MANIFEST .�. `2 . �. _>
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<br /> O 15 Speciol Handling Instructions and Additional information
<br /> i' CTIVE .LOTI3NG ��1vtl✓�.�.YEI.0� RESPONSE
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<br /> I hereby declare that the contents of this const nment are fully and'accurate) described above.by proper ship ing'name and Oredassihed,packed,
<br /> 16..GENERATOR'S CERTIFICATION.- y
<br /> is in'to per condition'For transport by highway according to applicable international and notional 9overnment_regulations., _
<br /> tri all respects -- ..-
<br /> d 'and are p P
<br /> a marked,
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<br /> {{I am a large quaniiyl ei
<br /> generator,I certpify that I hove a pro ram in,pI ce'to reduce the vdlume and toxicity of waste generated to the degree I havndfuture threat
<br /> a to humnomically
<br /> P � all'quantity enerfitar,gg'I have made a ood faith'eFforl.to minimize m waste'generation and select the best waste mono refit to human heaHh
<br /> r' ii roctfcoble and that I ave selected the racticable method of treaiment,storage,"or disposal current) available to me which minimises the resent and future tyeinent method tfiat is
<br /> l -. .and the environment;OR,if I am a sm q ty g _ .. _ `.,--.'-- -
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<br /> available to me and that I can affoM.'.
<br /> Month, Day Year
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<br /> T 17. Trans orter 1 Acknowled ement of Receipt of Mbteriafs �' -
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<br /> u 19.-Discrepancy indicationSpace
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<br /> i l 20. Faci[i Owner or O erotorrCertification of recei t,of hazardous m terwls covered b this'moniFest exce t as noted m Item 19-: Month D Year
<br /> 'Signature �'
<br /> . T .Print /Typed Nome _ /r'Z :[ .fit.
<br /> DO NOT WRITE BELOW THIS LINE..
<br /> Yellow: TSDF SENDS THIs.COPY TO GENERATOR W.[THIN 30 DAYS.
<br /> (Generators who submit hazardous waste for transport out-obstote,
<br /> DISC 8022A 11/99) produce completed copy of this copy and send to DTSC.within 30 days.)
<br /> EPA 8700=22
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