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I =:dor X1ipt�oi�h/ ,I�Afl�p ;; � :-�i� k-t��w*TF � ��-�� nt��.• �" " � <br /> { S_.��-1^^^0r tY�. 5�•��r �sae Qa l.�i�-,IYP�„� �} f Y���r� x�' �. W �.�'[W{�11 _ _ <br /> UNIFORM HAZARDOUS 1. Oeneratar's US EPA ID Nor. <br /> WASTE MANIFEST' EN I Doctanent No” . in.fhs ehedad; ` , <br /> 9. tieneretor a Name and Mailing Address 15 not required by Fedenf•law <br /> F. f. <br /> 0 4. Generators Phone 04� IVY- <br /> �T A <br />``\ip 5. Treneporter 1 Company Name 8. US EPA.ID.Number E <br /> ��° C+ els <br /> CA Uy 717 1111AiP, Tftmloorowlll� <br /> 7. Tranap r 2 Com any Name 8. US EPA !D Number <br /> E. State lf5nnportet+s ID <br /> , F. Traheporter'a P}lone- - _ II <br /> 9. Designated Facility Name and Site Address 10: US EPA ID Number O. Slate FaeilRy'a IDAm <br /> ' l <br /> Jf-yz\p ' <br /> Z <br /> r ' { <br /> 121-Containers 19. Total t4. I-• <br />�M!f0i 11. US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) <br /> Quantity Unit waale7o: <br />•�(Qj a. No. .. Type wt/vol _ <br /> 30 Z G + State ' <br /> EPAIGIthar <br /> 3 N <br /> E b. :- <br /> N R <br /> AOR .• ; n <br /> TO EPA/Other <br /> I <br /> State <br /> y, to a <br /> EPA/ or�u i <br /> Z J. Addilkmaf Descriptions for Materials Listed Above.-'. + r 1( ►trgng Wastes Usted <br /> a. <br /> uj <br /> d1.1 I <br /> Zf ,�' ! .a1•," ?5 S'�,� - , y bad } ?. , ,�, i <br /> Q 15. Special Handling Instructions and Additional Information i <br /> Z <br /> w <br /> J <br /> J <br /> Q 18. <br /> U <br /> J <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are full and accurately described above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are In all respects in.proper condition for transport try highway according to applicable international and <br /> IL national government regulatkxca. <br /> 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 <br /> 0 to be economically practicable and that I have selected the practicable lroathod of treatment,storage,or disposal cumotty available to me which minimizes the <br /> present and future threat to human health and the environment;OR.If1 pqc a small quantity generator,I.have made a good faith affoft to minimize my,waste <br /> Q Generation and select the beat waste management method that is available to me and that I can afford.'' <br /> Z <br /> tu Printed/Typed Name SI re i Month 1Day Year <br /> cc <br /> wt{ <br /> wR 17. Transporter 1 Acknowl4ilp tent of.Recelpt of terials <br /> Q A Printed/Typed Name Signa ay. Month Day Year <br /> N <br /> �? _ 1 r - I <br /> 0 p <br /> LL <br /> Lu O 10. Transporter 21ANnowledgement of Rdeelpt of Materials - <br /> T Printed/Typed Name Signature Month Day Year 1 <br /> E <br /> Z <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> f <br /> LLN <br /> I 20. Facility Owner or ator Certification of receipt of us materials covered by this m' st ex 't as noteviln Hem 1 <br /> T <br /> y Pri !TY d Nam Signature 7 MonfA Day Year i <br /> DHS 8022 A(1/88) Do Not Write Below This Line Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS' <br /> EPA 8700--22 <br /> (Flew.9-88)Previous edition&are obsolete. i E <br /> i <br /> I <br /> c <br />