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Oct 03 02 11 : 47a RIS 209 234 2711 p. 9
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<br /> '-Seale of Caiildmra—Environm.nlui Protection Agonq See Instructions on back of page 6. Department of Toxic SAO..,.,Cemrol
<br /> Form Approved OMB No.2050-0039]Expirm 9-30991
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<br /> 1, Gene udor" US EPA ID No. FVia a Document No. 2. Page 1 Information in the shaded areas
<br /> UNIFORM HAZARDOUS snot.,u.r.d 6y Funeral low.
<br /> WASTE MANIFEST ,; n f4I.,s . ., +..? 'd ,^,�, r t;L l_21 d 19 'h of I
<br /> 3. Generatar'a Nam.and Mailing Address A. stats Maniieal Document Numbn 21928490
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<br /> I V 11. US DOT Description(including Pro Shipping Name,Haeord Class,and ID Number) No1 2. Can Iciness 13. Total 14. Unit
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<br /> 16. GENERATOR'S CERTIFICATION: Ihereby declare that the contents of this consi9 nt are fully and occur.lalydescri6dabovebypm nrshiF ing name and am rimsilied.pocked,
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<br /> p-,condition for I.apo. y highway according to applimhln international and nutmnul government r.gdotiens.
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<br /> n praaica6le and 16at 1 live elected the practicable method o treatment,storage,or dinpe dinn'.9lly a.adoN.la me whiib_ ce the presonl and Future threat Io human hex:Z
<br /> j and the environm.nt:09.if I oat.small yuanlily Renato,,I heve made a good 9itK eflorl tq millimi:e my w«Ie gY�roran 3qd soba the host wrote ma�agem.nl method Ihol is
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<br /> i Oy Printed/Typed Name SignWFire �i/ i �/1 Month Day Year
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<br /> 1 tic i i Traro oae.l Acknowle emeMg Recei to Materiels
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<br /> i DO NOT WRITE BELOW THIS LINE.
<br /> Blue: GENERATOR$ENDS THIS COPY TO DTSC WITHIN 30 DAYS.
<br /> DISC W22A 11/991 To: P O. Sox ADD, Sacramento, CA 95812-OAOD
<br /> EPA 8700-22
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