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more ofCalife��Pm� Age,, <br /> Farm App vod OMIT No.2050-0039(rm wes 9-30. *) See Instructions on back of 04 <br /> •Please pnnr or-type. Form des.gned tar vse on etre(i7-pitch)>t ter. 6' Oepartmere of Toxic S-600rces Camrol <br /> Sacramento,Cdifomiq <br /> UNIFORM HAZARDOUS 17U;nerwors US EPA fl)No* <br /> Manifest D_onrmeM No. 2. Page I Infomtation in the shaded areas <br /> WASTE MANIFEST' <br /> r is not required by Federoi low. <br /> 3. Gerserator's Nameor <br /> and Mailing Address <br /> Ln <br /> A. Cxnerator's Phorte/a, <br /> M � a. �,�� d[`..J •fir�.+.vr.�., <br /> 8 <br /> 00 S. Transporter 1 Company Name 6. US EPA ID Number v+kv ( <br /> as r "r <br /> I� <br /> 7. Transporter 2 Company Name <br /> S. US EPA 1D Number <br /> Q x. <br /> - - <br /> � I I <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number <br /> I 3. US DOT Description(including Proper Shipping Nome,Hazard Class,and ID Number( 12. Comorners 1 13. Total 14. Urm <br /> a. <br /> i No. Type 1 Quantity ' wt/vol i <br /> ao N b. <br /> co <br /> E I ! I <br /> R ([ t <br /> A <br /> Tco <br /> O <br /> vJ <br /> 0 15._Special Handling Instructions and Additional information _ <br /> :L <br /> HE. 2- =-R - gyp• -rc�.n•. ` <br /> 16. GENERATOR'S CERTIRCATION: I hereby declare that the contests of the consignmem are ivlly and accurareiy described above by proper shipping name and are classified. <br /> packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable federal,stare and intemationai laws. <br /> i <br /> 1 If I am a large quantity generatorr 1 certify that I hove a program in piece to reduce the vofvme and toxicity of wane generated to the degree I have cieterteised to be ! <br /> y <br /> economically practicable and that I have selected the practicable method of treannent,"rage,or dis osai N g p rtrmly available to me which minimizes the present and future <br /> V) threat to human health and the environment; OR, if I am a small quantity generafor, I have made a good faith effort to minimize my waste generation and seiecr the best I <br /> waste mono ement method that is ovoiiob6 to me and that 1 can afford. <br /> Prittte VTyped Name I Signature .r i r- t Montti rf % <br /> Z T 17. Transco r 1 AcknovAedoement of Receiot of Materials <br /> R <br /> Primed/Ty mti - n Signature / )r— <br /> month! Daaatf <br /> � r I <br /> o18, Trans iter 2 ,cksowhedoement of Receipt of Mareriais <br /> W R <br /> T Printed/Typed Name Signature ' Month Day Year <br /> R <br /> R i <br /> 19- Discrepancy Indication Space <br /> Q F <br /> V A <br /> G <br />�I 1 <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materiah covered by this moniiest exceat as noted in Item 19. <br /> T Printed/Typed Name Signature Month Day Year <br /> Y <br /> DO NOT WRITE BELOW THIS LINE. <br /> SC 8022A (7/921 <br /> A 8700-22 <br /> Yefkaw: GENERATOR RETAINS <br />