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05404/2005 22;55 FAX. 00103 <br /> Farm 4praied 00,45 Na 20 j-'Y See Instructions on back of N Im,mrafToric s.lain"aaac <br /> ,20 1 39(Expire69-3D-991 <br /> _-Nowpnritorrypo. PanneeaSnod fI on vlit.(12-pikh)lyptnenlw. sauamenlo,califorrim <br /> C,er,rai.e.US EPA 10 No wa.ifiry Coommm,No 2. Page I In tint,in the shaded areas <br /> AL <br /> UNIFORM HAZARDOUS 1,not uired by Federal 6, <br /> WASTE MANIFEST =-j Icti 11.4 P P P <br /> 3. CentrI No..and Mailing Address �A. <br /> -143 <br /> 14-4:14 N.Hill?-8* <br /> 0 A, Camendar',Phone <br /> 5. Tronspertae 1 Company No. 4. US EPA ID Member C_ [RanaI <br /> no <br /> no <br /> R-, D <br /> 6 <br /> 7. Tions"I 2 Company Nome B. U$EPA ID Number <br /> P <br /> r>r)o: ,TqnipVmir%Phone <br /> F �73--,oI <br /> ou Da9. led III Nome and Sra Addr.I 10. US EPA 10 N..6a, c; <br /> H ]`,Vin',PI <br /> j <br /> 0. <br /> a,and ID Number) 12. Container, 13. Tend IA. nil <br /> (d 11. US DOT Dam:nprion linduding Proper Shipping Nome Hoxord Clan, <br /> No, I fyi.- QUI I Wl d J-Wmh,:NInI <br /> z <br /> ff'i In!7C.- <br /> IF EPA/Cnher <br /> G 10")H 10 <br /> N <br /> E EPA/0I <br /> T <br /> oy 0 VAI <br /> U <br /> -Ep 7A/011h., <br /> I I; <br /> K H�ndlincmlanjr <br /> fiSiarmakI AbI <br /> g <br /> S <br /> on 4 <br /> b <br /> C. <br /> 15. 51 Hadln,tru0i..,and Addihenal <br /> lnfo,.*K.n <br /> i's .7, 4 Pix-I rer�� i.-7: <br /> p P <br /> Z <br /> 7, <br /> =i 16. GENERATOR'S CERTIFICATION; I II d.1m.that the it of iI ft,; n ora Fully and occinawl dasnrilbad ba,.by Fra,I name 04 lore cicraffid,peaked. <br /> -< marked,and labeled,and am in all reapmI,In II govanuremfl'uhalion, <br /> IJ <br /> -2 IF I am a I.,w qu..Ii,,simona.,I certify lh.t I ho,,.pron.�;.Floor r,red..the.[..n and naIrdt, F walla reathed to the degree d Inairud to be nano.aI <br /> si p'.6colAt and that I III talsolk the pnna;.61..,,had. treatment, IaI at d;jwI Cunnmily anoilol,la to me whirl i.m.the'I U.11116 human hophr <br /> and the OR,IF I am IIIIInm9ly so 14-101,1 ht.9.a .d FI to minimize my .Ie gararag.n end select the 6.,westl auma,mmm,..,had that is <br /> ..ila6l.In ma and the,I c...&I <br /> 0 <br /> PwradOypind N..e month only Y. <br /> IF <br /> Z3 T T7.Tn:m;qrmrIAc6 dpmnmI.FR..Ipl.FMeI <br /> lAor <br /> Pvi.%d/7ypd Ntnoa mh Day Y. <br /> 2E 14A <br /> ILL p <br /> 19. Toho pI 2 AI,kn. mmft*...I M014I <br /> 0 i Printad/TyPod Nome Signature, month Day Y. <br /> U IV. DiscraanbralwafienSpam <br /> F <br /> A <br /> C <br /> 1 <br /> T PHI,led/Typad N... Slim.l.ry �;Xth Day Y. <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) <br /> EPA 07M-22 <br />