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Environmental Protection Agency - %j7.-.• t^ '1
<br /> al• MB No.2050-0039(Expires 9-30-99 A�"f`t
<br /> �at ( P' I See Instructions on back of p a 6. Department of Toxic Substances Control
<br /> ar type."Form desiSned for use on efiteI12-pitch/ iter. Sacramento,California
<br /> 1. erator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas
<br /> UNIFORM HAZARDOUS
<br /> WASTE MANIFEST
<br /> C AD 0a 74 s 4r:;wt^0 d t is not required by Federal law.
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<br /> 3. Generator's Name and Mailin Address i#1 '...•..$f...d Y to A f.,:' �;;:, -}, j'ti•(i«. �j'}
<br /> 0 29' "a ISF�C R t ail ti(I) A State Mant#est Document Mtrm6er
<br /> }..C"I"D i g.. 4 s a t v`"" 6 State faett4aator a t£1` t$t qs
<br /> 4. Generator's Phone Q'.)9 j 3 3 33 5 0 0 a v ter h^�$frl
<br /> N 5. Transporter 1 Company Name
<br /> p q�{ t ^r y p` 6. US EPA IID NumberOD
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<br /> 7. Transporter 2 Company Name 8. US EPA ID Number :ytct4 l sgslsf#optEpe {F deserve L gram r
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<br /> J F.'Trctnsparter s Phone
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<br /> V 9 Designated Facility.Name and Site/,�*ess•, 10. US EPA ID Number G'State Facai a {s ID f
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<br /> H. Facility's-Phone
<br /> Q 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit
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<br /> Z_ o. No. I T pe Quantity Wt/Vol 1. Waste Number
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<br /> 1.:Addthan-of Descrtpteans�orJvlatertafe Crated Aboveo
<br /> K:tiandling @odes ksr Wastes Listed Above
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<br /> Q16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed,
<br /> V marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. (1
<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 to be economically `.
<br /> N practicable and that I have selected the practicable method of treatment,storage,or disposal_currently available to me which minimizes the present and future threat to human health
<br /> and the environment;OR,if I am a small quantity generator,I have made a good faith,ef%rtto 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 o r1 „tt t ,. ,. >j�� .. ,,'9 Signature ! r, �.. ��' +' ^~ r°
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<br /> oA 17. Transporter 1 Acknowled enfant of Recei t of Materia
<br /> W A Print d/)typed Name
<br /> N ` Signator®
<br /> Month::E Day Year
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<br /> 0 18. Trans orfer 2
<br /> Acknowledgement of Receipt of Materials ' }
<br /> T Printed/Typed Name "}
<br /> NE Signature Month Day Year F
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<br /> V F 19. Discrepancy Indication Space.
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<br /> 10. Fa.ility Owner or Operator Certification of recei t of hazardous materials covered by this manifest except as noted in Item 19. J t`
<br /> T Printed/Typed Name Signature
<br /> Month Day Year
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<br /> DO NOT WRITE BELOW THIS LINE.:
<br /> DTSC 8022A(1/99)
<br /> EPA 8700-22 Yellow: GENERATOR RETAINS y
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