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. ...• rw...a..a.eora.cuov—ossa(expires1130-815) <br /> t w IvoaToxic$upalanps Control Dr. <br /> _ . (form dealaned/w ue n^":e(11-OR°n bpewnfe/1. Sacramento,Calu <br /> UNIFORM HAZARDOU 1 Generator a Us EPA ID No. Men. 2. Page I Information in the shaded a,aa <br /> WASTE MANIFEST _ Docamem.to <br /> ` J (� of is not required by Federal law <br /> 3. e e alor' Nam and Mail, Above" A. Stan Madleal Document Number <br /> /�Cf��c�/Vj /c,(�y P/3 8795 - 3 <br /> lr� e, watt a.n..ator•to <br /> L Generator's Phone 4rcrp ?(,_r, �/5 `/ �"' <br /> /) C 7 / I. <br /> b TrensVonar) Co any Name 8. US EPA ID Number C. Stag Tranaportara IR��;;j <br /> . / 1 7,. .�✓')� C. Q , Y Cl C. .� �, D. Tnnaponera Pho C1e <br /> 71. ,T,ra'nsponor'27—Company Name a. US EPA ID Number E. SMb Tranapplar' <br /> a, V✓ —) l r / �� t^.7 — Cf F. Tnnaponer'e Phon 7 / _ <br /> 9f...�''Deugnaled Facility Name AMSitt..Address to. /[�l/$,EPA ID RrIter O. State Fa"My's ID <br /> H. F "Y's Phons <br /> f,37- <br /> 0 <br /> `,�� <br /> 11, US DOT Description(Inclutlmo Proper Stepping Name,Hazard Class.and to Number) 12. Corti Mors 130uanl4 Urn Wawa Nu. <br /> No. Type 111i <br /> w <br /> 3 G <br /> lvus�e yr 1 CvM +rb e (y,�� <br /> E <br /> N / <br /> 3 i ITT <br /> V <br /> E D. <br /> R SIN* <br /> to o <br /> m AT ar EPA/ON <br /> v <br /> Ncaw <br /> 0 <br /> R <br /> C. <br /> 0 <br /> m EPA7pMr <br /> � e. caw <br /> Z <br /> w <br /> O EPA/Ogler <br /> w <br /> Z J. Admhonal Description&to Malaria Listed Above K. handluq Codee for Waal"Listed Above <br /> o a. s. <br /> m <br /> W <br /> c. a. <br /> a <br /> Z <br /> 0 <br /> 18. Spacial Handing Instruction@ and Additional Information <br /> Z <br /> W <br /> r <br /> r <br /> a 18 .r <br /> `1 GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shippmv <br /> name and are classified. packed, marked, and labeled, and are in all respect• in proper condition for transport by highway according to applicable <br /> a international and national government regulations. <br /> m 11 I am a large quantity generator, 1 certify that 1 have a program,n place to reduce the volume and toxicity of waste generated to The degree I haw <br /> u dwwmined to be economically practicable and that 1 have selected the practicable method of treatment, storage, or disposal currently available lu <br /> O me which minimizes the present and future threat to human health and the environment; OR, if I am a &mall qusnbty generator. I have made a good <br /> > tadh*Ilan to minimize my waste generation and select the best waste management method that is available to m•and that I can afford. <br /> Z <br /> Z <br /> to printetl/TYpe Name / Signature afonin DAY y&a <br /> io <br /> to H 17. Transporter I ACknowl Mt of Rsce,pt of Materials <br /> N Print it Name / / Signature / Aafw Day yea <br /> O 1• <br /> to G I8. Tiansponer 2 Acknowledgem 1 W HecelPI of Materials <br /> < R PratediTypel Name Siplature Atlanta Oxy yea <br /> U t <br /> Z_ <br /> 19. oar opabcy indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> I 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this mamfeat except as noted m It@m 19. <br /> T Pmtad/Typed Name <br /> 1plswat" Month Day Ya.. <br /> CHS W22 A(1187) White: TSDF SENDS THIS COPY TO DOHS WITHIN 30 DAYS INSTRUCTIONS ON THE BACK <br /> EPA 8700-22 <br /> (Rev.9.88) Previous edilass are obsoare. To: P.O. Box 3000, Socrigmento, CA 95812 <br />