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tope of Col+forma--Environmenlol Protection Aggency <br /> m Approved OMB No 2050-0039(Expires 4 30 99) See Instructions on back of page 6 department of Toxic Substances Contra! <br /> se pr nl or type form designed for use on elite(12 pitch)typewriter Sacramento California <br /> UNIFORM HAZARDOUS I Generator's US EPA ID No Manifest Document No 2 Page I Information is the shaded areas <br /> is not required by Federal low <br /> WASTE MANIFEST 10 - , AU -7 9 oft <br /> 3 Generator s Name and Mailing Address /l Q LU 1 P 'eta t�7 <br /> ro EL f�racto _ <br /> 4 Generator's Phone pev ).r4,7 <br /> 5 Transporter 1 Company Nome 6 US EPA ID Number <br />� .,ru <br /> i, t r +'� i r r.. <br /> ,rs� . .� r i. r r1� 1 vfrv.r t w vii. <br /> aLr <br /> 7 Transporter 2 Company Name 8 US EPA ID Number , <br /> r� <br /> �i <br /> 9 Designated Facile Name and Silo Address 10 US EPA iD Number " <br /> INUUg I HIALSLHVICIL VIL LQ. WI. <br /> ?(JQ 5 ` OTO tiT <br /> l,l1, vJ'i tJ tJVGV { <br /> 11 US DOT Descriphon(including Proper Shipping Nome,Hazard Class and ID Number) <br /> 12 Containers 13 Total 1 d Unite <br /> No T e Quantity Wt/Vol il AO'ste M eCLvxr'C� <br /> a NON-RC RA HAt•A1111101 IR WASTF" f IOt fin <br /> 5 0-tv, WAr-rlr + EP,A/owii <br /> N b estate> -€ { •: <br /> E .. <br /> R o J, <br /> A ' �r <br /> T <br /> Q <br /> EPA`/�Qthey� <br /> 1�A tfi <br /> 2 xr Sn <br /> 15 Special Handling Instructions and Additional Information <br /> (iLOVEy <br /> EMIERGENrY PHONE 209-6137 (01157 <br /> I <br /> 16 GENERATOR'S CERTIFICATION I herelt declare that the contents of this consignment are full and accurately described above by proper shipping name and are classified packed <br /> marked and labeled and are in all respects in proper condition for transport by highway according to applicable international and nahoric government reguloltons <br /> If I am a large quanli generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I hove determined to be economicolly <br /> procticoble and that I have selected the practicable method of treatment,storage or disposal currently available to me which minimises the present and future threat to human health <br /> and the environment,OR,iF f am o small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> available to me and that i can afford <br /> Printed/Typed NameC� l ` ll. t <br /> ::Uonth <br /> /Day Year <br /> ignatut 21 <br /> R 17 Trans ortsr 1 Acknowled s e of It n t of Materials <br /> A Printed/T d ome Signatu Month Da Yesr_ <br /> 118 sorter 2 Acknow amens of Recm t of Materials <br /> R Prinled/TYp ed Noma Signature g Month Day Year <br /> 1 <br /> E <br /> R <br /> 19 Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> L <br /> 20 Facday Owner or Operator Certification of recet t of hazardous materials covered b this manifest exce t as noted in Item 19 <br /> Printed/Typed Name Signature Month Day Yeor <br /> DO NOT WRITE BELOW THIS LINE. <br /> C 8022A (4/97) <br /> 8700-22 Yellow GENERATOR KET-INS <br />