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Q 15. Special Handling Instructions and Additional Information <br />24 <br />Q d wWK NA1*0tE ;" <br />Z <br />w { <br />..16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping narue and are: dassrfrecl <br />Qpacked, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable federal, state and intemationaf)aws <br />J d <br />If I am a large quantity generator, I certify that 1 have a' "ram in place to reduce the volume and toxicity of waste generates} to the degree I have, etermined 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 presets, qnd future <br />N threat to human health and the environment; OR, if 1 am a small quantity generator, I have made a good faith effort to minimize my waste generation and selecP the best , <br />waste mono ement method that is available tome and that I can afford. <br />Q Printed/Typed Name ' Signature Month Day Year <br />Z T 17. Trans outer' 1 Acknowled ement' <br />LU w ,.f!trrulgd TYPed Name <br />C9 N <br />W <br />P <br />ll -2 0-S, <br />State of California—Environmental Protection Agency <br />Form Appr�e si SO -8039 (Expires 9-30.94) <br />S@@ Instructions on back g@ 6. <br />Department Toxic Substances Control <br />i <br />Please print or 4ype"; s rm designed for use on elite (12pircfr) <br />Printed/Typed Name' <br />Sacramento California <br />' <br />" <br />r y <br />u UNIFORM HAZARDOUS <br />1.Generator's US EPA ID No. Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />is not required by Federal law. <br />WASTE MANIFEST <br />' <br />V <br />A <br />of <br />Z <br />C <br />3. Generator's Name and Mailing Address- <br />(e> <br />I <br />20. FacilityOwner or Operator Certifi; <br />Printed/Typed Name <br />T <br />Y <br />in <br />A 0 04 <br />C4 <br />4. Generator's Phone (; t+ <br />' <br />5. Transporter 1 Company Name <br />6. US EPA ID Number <br />o?one=# <br />AI <br />7. Transporter 2 Company Name <br />8. US EPA ID Number <br />V <br />Q <br />10. US EPA ID Number <br />9. Designated Facility Name and Site Address <br />I*ftZ <br />.. <br />:O <br />814,810,114 <br />V <br />Z <br />p..; <br />11. US DOT Description (including Proper Shipping Name Hazard Class, and ID Numb! ) <br />F <br />12. Containers <br />No. <br />Type <br />13 Total 14. Unit <br />Quantity Wt/Vol' <br />Q 15. Special Handling Instructions and Additional Information <br />24 <br />Q d wWK NA1*0tE ;" <br />Z <br />w { <br />..16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of the consignment are fully and accurately described above by proper shipping narue and are: dassrfrecl <br />Qpacked, marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable federal, state and intemationaf)aws <br />J d <br />If I am a large quantity generator, I certify that 1 have a' "ram in place to reduce the volume and toxicity of waste generates} to the degree I have, etermined 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 presets, qnd future <br />N threat to human health and the environment; OR, if 1 am a small quantity generator, I have made a good faith effort to minimize my waste generation and selecP the best , <br />waste mono ement method that is available tome and that I can afford. <br />Q Printed/Typed Name ' Signature Month Day Year <br />Z T 17. Trans outer' 1 Acknowled ement' <br />LU w ,.f!trrulgd TYPed Name <br />C9 N <br />W <br />P <br />0 <br />18: T a outer 2 Ac nowled emeM of <br />taJ <br />i <br />Printed/Typed Name' <br />LA. <br />® <br />.R <br />Discrepancy Indication Space. <br />N19. <br />V <br />A <br />Z <br />C <br />1 <br />I <br />20. FacilityOwner or Operator Certifi; <br />Printed/Typed Name <br />T <br />Y <br />DTSC 8022A (12/91) <br />EPA 8700--22 <br />Signature <br />9 y� <br />d, <br />t of Twerials Q` <br />Signature . <br />Signature <br />DO NOT WRITE BELOW <br />MonthDay Year <br />Month Day Yew . <br />em 19. <br />Month Day Year>` <br />i <br />Yellow: GENERATOR RETAINS <br />