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',tote of, ornio—Environmental Protection Agency <br />form Aµ d OMB No. 2050-0039 (Expires 9-30-94) See Instructions on back of be 6. <br />Please print or type. Form designed for use on elite (12 -pitch) ter. <br />UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. <br />WASTE MANIFEST <br />3. Generator's Name and Mailing Address f <br />O <br />W) <br />N <br />M 4. Generator's Phone <br />00 <br />p 5. Transporter 1 Company <br />� O <br />Wi <br />�— <br />�. <br />7. ianspo er ompany <br />.)4, 1 r (✓ ( "t fi1'�J <br />6. US EPA ID Number <br />t Control <br />Sacramento, e <br />2. Page 1 Information in the shaded are s <br />sy U1 rectre <br />of f A 49"1 I law. <br />Q 15. Special Handling Instructions and Additional Information <br />24 IfE. EHRGECY CONTACT. 4t441,a '�)- <br />Z 24 Ilk. FMERGEKY RESPphSF., t;}"t.�; T?.l, l:C. �`I t ;}- `i-39 4 <br />LU <br />APPROPRIATE PROTECTIVE, Ci,OTI 0P 6 tt V`PiRATQi,,. <br />16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br />J <br />packed, marked, and labeled, and are in all respects in proper condition for transport b highway according to applicable federal, state and international laws. <br />Q P P� P P P Y 9 Y 9 PP " <br />V <br />If I am a large quantity generator, 1 certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined 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 present and future <br />Nthreat to human health and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br />a waste management method that is available to me and that I can afford. <br />Q Printed/Typed Name I Signature I Montes Day„ Ye <br />U <br />Z <br />4 <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />W <br />0A <br />R_ <br />N <br />Printed N' <br />e <br />Ws <br />p <br />1� _t.r �� " J p <br />I Ii f !/1/, <br />18. Tra s orter 2 Acknowled emen of Receipt of Materials <br />s;0 <br />• <br />• <br />T <br />Printed/Typed Name <br />LL <br />p <br />E <br />it <br />N19. <br />is <br />Discrepancy Indication Space <br />Q <br />F <br />V <br />A <br />Z <br />_ <br />C <br />i <br />L <br />I <br />20. Facility Owner or Operator Certification of receipt of he <br />T <br />Printed/Typed Name <br />v <br />• <br />Q 15. Special Handling Instructions and Additional Information <br />24 IfE. EHRGECY CONTACT. 4t441,a '�)- <br />Z 24 Ilk. FMERGEKY RESPphSF., t;}"t.�; T?.l, l:C. �`I t ;}- `i-39 4 <br />LU <br />APPROPRIATE PROTECTIVE, Ci,OTI 0P 6 tt V`PiRATQi,,. <br />16. GENERATOR'S CERTIFICATION: 1 hereby declare that the contents of the consignment are fully and accurately described above by proper shipping name and are classified, <br />J <br />packed, marked, and labeled, and are in all respects in proper condition for transport b highway according to applicable federal, state and international laws. <br />Q P P� P P P Y 9 Y 9 PP " <br />V <br />If I am a large quantity generator, 1 certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined 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 present and future <br />Nthreat to human health and the environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best <br />a waste management method that is available to me and that I can afford. <br />Q Printed/Typed Name I Signature I Montes Day„ Ye <br />U <br />Z <br />4 <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />W <br />0A <br />R_ <br />N <br />Printed N' <br />e <br />Ws <br />p <br />1� _t.r �� " J p <br />I Ii f !/1/, <br />18. Tra s orter 2 Acknowled emen of Receipt of Materials <br />s;0 <br />US <br />T <br />Printed/Typed Name <br />LL <br />p <br />E <br />it <br />N19. <br />Discrepancy Indication Space <br />Q <br />F <br />V <br />A <br />Z <br />_ <br />C <br />i <br />L <br />I <br />20. Facility Owner or Operator Certification of receipt of he <br />T <br />Printed/Typed Name <br />v <br />Signature <br />Signature <br />Signature <br />t� <br />this manifest except as noted in Item 19. <br />DO NOT WRITE BELOW THIS LINE. <br />Month Day Year <br />Month Day Year <br />DTSC 8022A (7/92) <br />EPA 8700-22 Yellow: GFNFRATOR RETAINS <br />