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<br />Slot* of CoWornlo—Environmental Proteclion Aaoncy
<br />Form Approved OMB No. 2050-0039 (Expires 9-30-99) See Instructions on back of *6, Department of ToxicSubstanees Central
<br />Please print or typo. Form dosignod for use on elite 172-04J typewriter.
<br />DO NOT WRITE BELOW THIS LINE.
<br />DTSC 8022A (1/99)
<br />EPA 8700--22
<br />TTOQ�
<br />Yellow: GENERATOR RFTAIN5
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<br />UNIFORM HAZARDOUS
<br />1. Generator's US EPA ID No.
<br />MoniFest Document No.
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<br />WASTE MANIFEST
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<br />is not required by Fodarel law.
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<br />3. Gonerotor's Nome and Moiling Address
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<br />A Steto Mnnif.,t pecvment Nvmlisr
<br />707 E. ROTE RD.
<br />B: 'State Generplor's •ID
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<br />5. Transporter 1 Compony Nome 6. US EPA 1D Number
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<br />7. Transporter 2 Company Name 8. US EPA ID Number
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<br />9. Designated Facility Nome and Site Address 10. US EPA ID Number
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<br />CLI'N!— AHCHO o=ORDOVA, LLC,
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<br />11, US DOT Description {including Proper Shipping Name, Hazard Class,12.
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<br />15, Speciol Handling instructions and Additional Informalitn
<br />APPROPRIATE PROTECTIVE CL 'BG
<br />rr ERGEWC C CC WT714T.- 000) 746-7449"
<br />SEE E.R.G. RAM # 171
<br />16, GENERATOR'S CERT1rICATION: I hereby declare thol Ike contents of this consignment are fully and accurately described above by proper shipping nome and ore classified, pocked,
<br />labeled, in in for by highway to international
<br />marked, and and are all rospecm proper condition transport oceording
<br />opplicoble and national government regulaFrom.
<br />IF 1 om a large yuontity generator, I certify that I hove a program in place to reduce the volume
<br />and toxicity of waste generated to the degree I have determined ro be aconomieally
<br />Future human health
<br />practicable and that I hove soloerod the procticable method of treatment, stora9o, or dispoea) currently ovoifoble to me which minimizes {ke present and tkreal to
<br />faith the bear is
<br />and Ike environment; OR, if I am a smolt quantity generator, I have mode a good effort
<br />to miize^Wry. ste generation and select waste management method that
<br />available to me and that I con afford,
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<br />17. Tram orter 1 Acknowlad ement of Receipt of MaterlalI `
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<br />18. Transporter 2 Aelinowled ement at Recei r of Materials
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<br />19. Discrepancy Indication Space r
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<br />20, Foc;lity Owner or Op.valor Cerlificorion of receipt of hazardous materials covered 6X this monifesl except os noted In Item 19,
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<br />Prinlad/Typed Name
<br />Si®nature
<br />Month Day Year
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<br />DO NOT WRITE BELOW THIS LINE.
<br />DTSC 8022A (1/99)
<br />EPA 8700--22
<br />TTOQ�
<br />Yellow: GENERATOR RFTAIN5
<br />%bd 9t:00 9TOZ/6T/b0
<br />
|