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<br /> State of California—Environmental Protection Agency _. See.Instructions on back of; b• Department o4 Toxie SuEsstances Control
<br /> Form Appro ed•OMB .2050-0039(Expires 9-30-99) Sacramento,California
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<br /> Please prin or pe. FBr r+designed for use on elite(12 2-pit �?ef 2 Pae 1 Information in 1he shaded areas
<br /> Generator's US EPA ID No. 'Manifest Document g is nvt'required by Federal law.
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<br /> ' R WASTE MANIFEST ►' ^'( t w
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<br /> 3 Generator's Name and Mallin Address -
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<br /> c:l 5f.Jrans Orter 1.Campo`�ykNome f. 6. US EPA SD Number
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<br /> 7- Transporter 2 Company Name 8. US EPA ID Number E State Transpbrler s tb(Reserved
<br /> V 10. US'EPA ID Number , G Sfnte Fanlitys
<br /> 9. Designated Facility Name and Site Address: y.
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<br /> 12. Containers 13. Total IA. Unit
<br /> 11 US DOTDescription(including Proper Shipping Name,Hazard Class,and ID Numbed No. T pe Quantity' Wt/Val I VVoste Number=
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<br /> 15. Special Handling Instructions and Addrtronai Information
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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 shipping name and are classified,packed,
<br /> Vmoiked"and labeled,and are.in'all respects in proper condition for transport by.highway according to applicable international and nations_I government regulations. -
<br /> 1{I'am,d lYxrge'quaniiiy generator,I certify that I hove,a program in plots to reduce the volume and toxicity of waste generated to the degree I have determined to be.economicallyy
<br /> prdcticabie and that I hhave selected the practicable method of treatment,storage,or'disposal currently available to,me which minimizes the present and future threat to human.heaith
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<br /> and the�tivironmenl;OR,if k am a small quantity generator,I have mode a good faith effort to minimize my waste generation and select the best waste management method that is
<br /> ac available to me and that I can afford
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<br /> U -Printed,�Ty,{7td Name Signature' J Month,l Day Year r
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<br /> T 17. Trans oder 1 Acknowled emenT of Ratei t of Materials _
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<br /> A ' Pint cl Typed Name Sigr�srture Wr. +, Y
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<br /> LL 0 18. Traniporter 2 Acknowledgement of Receipt of Materials - -
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<br /> V19. Discrepancylndicotion Space
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<br /> ., 20. FacilityOwner or operator Certification of receipt of hazardous materials covered b this manifest exce t as noted in Item 19.
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<br /> DO NOT WRITE BELOW THIS LINE.
<br /> ._ DTSC 8029A (1199) Yellow: GENERATOR RETAINS
<br /> EPA$700-22
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