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;.. -yl _. r �a �`w ;,^'E"F�,� _, ya ��_s6 � "Falx k`� �' t ru r -..;' -•'i°���{4��R ,,E•„ <br /> P.,of CalNomia nvironmentai Protection Agency c r r 4 <br /> form Approved OMB No.2050 0039(Expires 4-3094) See If1Sirucflaflf Oft`baric off Deportment of Toxic Salxtancei Comrol <br /> Please print or type. Form designed for use on elite(T2-pitde)1yp'ewrner. Y 1•:"•t-.-: Sacramento,California <br /> I. Generator's US EPA ID No. Manifest Document No '2. Page 7 Information in the shaded"areas <br /> UNIFORM HAZARDOUS .t a': is not required byFederaHaw.'J" <br /> WASTE'MANIFEST f' L of <br /> 3. Generator's Name and Mailing Address. <br /> r <br /> C4 e <br /> 4. Generaror's Phon <br /> co <br /> 5- Transporter 1 Company Name S EPA ID Number <br /> �'i YJL Ir S C <br /> 7, franlPoAir 2 Company Name" 15. US'EPA-ID Number <br /> Q 9, Designated Facility Name and Site Address 10. US EPA ID Numbe <br /> /? ! t-,'S/f r: f f. ;i:•,_ w!T:f '( !f'r" .",�f' -r'.. <br /> V 12. Container 13. Total 14. Unit <br /> 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) :1 <br /> Z Type Quantity Wt/Vol <br /> LO <br /> C\J!= <br /> G ". <br /> �O E <br /> oo N b. <br /> 00 <br /> EON 'W, <br /> c4 <br /> T C. <br /> 0o O � <br /> I' W R <br /> Z d' <br /> LU <br /> V <br /> w I <br /> 0 t «: <br /> a ` <br /> W <br /> CX r <br /> J £ <br /> Q <br /> t 0 15. Special Handling Instructions and Additional Information <br /> i <br /> E _ 1414 0-1G <br /> 16, GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br /> Qpacked,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,state and international laws. <br /> V �o <br /> j If I am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be <br /> economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future <br /> CL <br /> threat to human health and the environment,OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br /> a, waste management method that is available to me and that I can afford. <br /> Q Printed/ ped Name f' Signature ' , Month Day Year <br /> f J. <br /> r J' � .� . 'f F�r.c.`.' ''z'`. j:Y• r-,,; r {/ .I ;;�,t / ,''f' { J"- % ✓':f`{ <br /> ZT 17, Trans rter 1 Acknowledaemenl'of Receipt of Materials <br /> LU R <br /> n Printed/Typed Name Signature Month Day Year <br /> NJ <br /> 0 18. Trans rter 2 Ackrw- 1 d ement of Recei•t of Materials <br /> US A Printed/Typed Name Signature Month Day Year <br /> u- <br /> E <br /> O R <br /> LU 19. Discrepancy Indication Space <br /> to ' <br /> V A <br /> i Z C <br /> i <br /> L <br /> 1 20. Facility Owner or O erator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> 1 T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> Prc- foo f.ec( a--r)jolt Q-�MS(S'� <br /> 11 Frt�M V r- ecrrg CTlan 're.ST ort <br /> DTSC 8022A {7/92J <br /> EPA 8704-22 ;, Yellow: -ENERATOR RETAINS <br />