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<br /> State of Coliforgia—Enviro Mal=P{otecfibn Agency See;'IfigrUefilon.s on. _ _ Sacramento,Cali omio
<br /> `Form'�Approved OMB No. �D39{Expires 9.30.99)'- writer.
<br /> please print or type. Form designed for use on efite(12•pifch)4�^, - Manifest Document N '. _ 2.- Page 1 Information in the shaded areas
<br /> t ierator'i US EPA ID No is not required by Federal law.
<br /> UNIFORM HAZARDOUS �i ' of
<br /> WASTE' MANIFEST T-) Z �! +� 7 A` Stole Mam#est Document Number ,/y�)
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<br /> 5100 Sheila
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<br /> Phone 3.23 E 214»r320
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<br /> ,16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of,this consignment are fully and accurately described above by proper dhipping name and are Bassi
<br /> Umarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations.
<br /> of I have o ro ram in place to reduce the volume and toxicity of waste generated to the degree I have determined to he economically
<br /> 1 If I am a large quantity generator,I certify that p
<br /> " a practicable and that 1 have selected the P�racticable method aE treatment,storage,or disposal currently available to me which minimizes the present and futureagem threat to human haolth
<br /> rA and the environment;OR,if I am o small'quantiiy generator,I have made a good faith effort to minimize my waste generation and select the best waste managameM method fhaf'is
<br /> O available to me and that I can afford. T" Month Day Year
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<br /> lFri d/ ped Name f •_, ..� e.yr- 4..rr C.7" F
<br /> 17. Frons itSignai
<br /> iter 1 Acknowled ement aF RAce; t of Materials Month D_ay Year�-
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<br /> U_ p 18. Transporter 2 Acknowled ement of Recei t of Materials Month- Day Year
<br /> O S 'Printed/Typed Name Sidnoture -
<br /> V19. Discrepancy indication Space `-r••.r,. -
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<br /> j. 20- FacilityOwner or O erator Cerlificatioi,of r ei t of hazardous materials covered 6 this manifest exce t as noted in Item 19. Month Day Year
<br /> #' T Printed/Typed Name Signature
<br /> t. '° DO NOT WRITE BELOW THIS LINE.
<br /> Yellow: GENERATOR RETAINS
<br /> t`• DTSC B022A (1/99)
<br /> �E' EPA 8700-22
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